Healthcare Provider Details

I. General information

NPI: 1467756569
Provider Name (Legal Business Name): BRIDGET LENNON PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2011
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 MAIN ST # 317
BEACON NY
12508-2732
US

IV. Provider business mailing address

1607 ROUTE 300 STE 115
NEWBURGH NY
12550-1738
US

V. Phone/Fax

Practice location:
  • Phone: 212-801-2082
  • Fax: 914-371-3847
Mailing address:
  • Phone: 212-801-2082
  • Fax: 888-706-1331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number402805
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: