Healthcare Provider Details

I. General information

NPI: 1942163837
Provider Name (Legal Business Name): BRIANNA BRIDGEWATER
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 NEW RD STE A302
PARSIPPANY NJ
07054-5624
US

IV. Provider business mailing address

239 NEW RD STE A302
PARSIPPANY NJ
07054-5624
US

V. Phone/Fax

Practice location:
  • Phone: 973-298-0763
  • Fax:
Mailing address:
  • Phone: 973-298-0763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberB73950966457992
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: