MEDICARE: BRIDGEVIEW CLINICAL SERVICES, LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor
2	101YP2500X	Professional Counselor	180.004290	IL

General Provider Information

NPI Number	:	1427365527
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIDGEVIEW CLINICAL SERVICES, LTD

Provider Business Mailing Address
First Line	:	1813 N MILL ST STE F
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60563-4872
Country	:	US
Telephone Number	:	630-536-8073
Fax Number	:

Provider Business Practice Location Address
First Line	:	1813 N MILL ST STE F
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60563-4872
Country	:	US
Telephone Number	:	630-536-8073
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. NETALI CHOPRA
Credential	:	LCPC
Telephone Number	:	847-942-2512

Provider Enumeration Date	:	09/10/2010
Last Update Date	:	10/02/2024

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