Healthcare Provider Details

I. General information

NPI: 1912699596
Provider Name (Legal Business Name): BRIDGE INTERFAITH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2023
Last Update Date: 05/23/2023
Certification Date: 05/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 ROUTE 9 SOUTH
MARMORA NJ
08223
US

IV. Provider business mailing address

507 ROUTE 9 SOUTH
MARMORA NJ
08223
US

V. Phone/Fax

Practice location:
  • Phone: 609-840-6034
  • Fax: 609-840-6313
Mailing address:
  • Phone: 609-840-6034
  • Fax: 609-840-6313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. SANDRA LYNNE MCGARVEY
Title or Position: DIRECTOR
Credential: LPC
Phone: 609-840-6034