Healthcare Provider Details

I. General information

NPI: 1982410163
Provider Name (Legal Business Name): BRIDGEVIEW CLINICAL SERVICES, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2024
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14722 S NAPERVILLE RD UNIT 110A
PLAINFIELD IL
60544-3302
US

IV. Provider business mailing address

1801 N MILL ST STE M
NAPERVILLE IL
60563-4866
US

V. Phone/Fax

Practice location:
  • Phone: 630-536-8073
  • Fax: 630-839-9121
Mailing address:
  • Phone: 630-536-8073
  • Fax: 630-839-9121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NETALI CHOPRA SANGHVI
Title or Position: EXECUTIVE DIRECTOR
Credential: LCPC
Phone: 847-942-2512