Healthcare Provider Details

I. General information

NPI: 1831920552
Provider Name (Legal Business Name): BRIDGE MENTAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2024
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2014 S TOLLGATE RD STE 209
BEL AIR MD
21015-5904
US

IV. Provider business mailing address

PO BOX 993
ABINGDON MD
21009-0993
US

V. Phone/Fax

Practice location:
  • Phone: 410-324-0599
  • Fax:
Mailing address:
  • Phone: 410-324-0599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL

VIII. Authorized Official

Name: SAMUEL F POGGI
Title or Position: CFO
Credential:
Phone: 410-324-0599