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General NPI Number Information
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NPI Number | 1104308717
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Entity Type | Organization
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Legal Business Name | BRIDGES TO BRIGHT FUTURES,LLC
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Dates
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Enumeration Date | 08/30/2018
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Last Update Date | 07/01/2019
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Provider Practice Location Address
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Address Line | 95 DURKEE LN
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City | EAST PATCHOGUE
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State | NY
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Zip | 11772-5818
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Country | US
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Telephone | 631-286-0343
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Fax | 631-569-2007
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Provider Business Mailing Address
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Address Line | 95 DURKEE LN
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City | EAST PATCHOGUE
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State | NY
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Zip | 11772-5818
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Country | US
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Telephone | 631-286-0343
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Fax | 631-569-2007
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Authorized Official
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Title or Position | OWNER
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Name | MRS. CAROLINE CATHERINE BRABAZON-WILKINSON
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Credential |
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Telephone | 516-672-9792
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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