Healthcare Provider Details

I. General information

NPI: 1154870368
Provider Name (Legal Business Name): BRIDGES PSYCHOLOGICAL SERVICES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2016
Last Update Date: 10/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2747 CONEY ISLAND AVE
BROOKLYN NY
11235-5004
US

IV. Provider business mailing address

2747 CONEY ISLAND AVE
BROOKLYN NY
11235-5004
US

V. Phone/Fax

Practice location:
  • Phone: 917-586-5652
  • Fax:
Mailing address:
  • Phone: 917-586-5652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number014325
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT M MORRISON
Title or Position: DIRECTOR
Credential: PSY.D.
Phone: 908-377-3105