Healthcare Provider Details

I. General information

NPI: 1386292183
Provider Name (Legal Business Name): BRIDGET VAHER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2019
Last Update Date: 10/18/2019
Certification Date:
Deactivation Date: 08/28/2019
Reactivation Date: 10/14/2019

III. Provider practice location address

1444 5TH AVENUE
BAY SHORE NY
11706
US

IV. Provider business mailing address

394A LENOX ROAD
HUNTINGTON STATION NY
11746
US

V. Phone/Fax

Practice location:
  • Phone: 631-650-0115
  • Fax:
Mailing address:
  • Phone: 631-813-9403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number106554-01
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number106554-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: