Healthcare Provider Details

I. General information

NPI: 1801402417
Provider Name (Legal Business Name): COMMUNITY BRIDGES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2020
Last Update Date: 12/17/2020
Certification Date: 12/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 COUNTY ST
NEW BEDFORD MA
02740-5405
US

IV. Provider business mailing address

720 COUNTY ST
NEW BEDFORD MA
02740-5405
US

V. Phone/Fax

Practice location:
  • Phone: 586-567-2090
  • Fax:
Mailing address:
  • Phone: 586-567-2090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: CAROLYN BURKE
Title or Position: PRESIDENT
Credential: MFT
Phone: 508-656-7209