Healthcare Provider Details

I. General information

NPI: 1972743631
Provider Name (Legal Business Name): CYNTHIA A BRIDGMAN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2009
Last Update Date: 01/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1465 PIPESTONE RD
BENTON HARBOR MI
49022-2116
US

IV. Provider business mailing address

PO BOX 2257
CHESTERTON IN
46304-0357
US

V. Phone/Fax

Practice location:
  • Phone: 269-944-9274
  • Fax:
Mailing address:
  • Phone: 219-926-8320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number908
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801089898
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: