Healthcare Provider Details

I. General information

NPI: 1710242870
Provider Name (Legal Business Name): BRIDGE PARTNERSHIP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2012
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2228 BLACK ROCK TPKE STE 303
FAIRFIELD CT
06825-3237
US

IV. Provider business mailing address

2228 BLACK ROCK TPKE STE 303
FAIRFIELD CT
06825-3237
US

V. Phone/Fax

Practice location:
  • Phone: 203-292-6949
  • Fax:
Mailing address:
  • Phone: 203-292-6949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0-14-5069
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1-11-8521
License Number StateCT

VIII. Authorized Official

Name: MR. RICHARD P DOUGLAS
Title or Position: OWNER/DIRECTOR
Credential:
Phone: 230-292-6949