Healthcare Provider Details

I. General information

NPI: 1467823708
Provider Name (Legal Business Name): BRIDGET HEALEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2015
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

484 WORCESTER ST
SOUTHBRIDGE MA
01550-1409
US

IV. Provider business mailing address

484 WORCESTER ST
SOUTHBRIDGE MA
01550-1409
US

V. Phone/Fax

Practice location:
  • Phone: 508-981-6269
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number2549
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: