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General NPI Number Information
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NPI Number | 1144971953
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Entity Type | Organization
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Legal Business Name | BRIDGES OUTREACH, INC.
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Dates
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Enumeration Date | 01/13/2022
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Last Update Date | 01/13/2022
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Provider Practice Location Address
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Address Line | 35 HALSEY ST
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City | NEWARK
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State | NJ
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Zip | 07102-3047
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Country | US
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Telephone | 973-723-2307
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1444
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City | SUMMIT
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State | NJ
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Zip | 07902-1444
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. MICHAEL JOHN CALLAHAN
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Credential | DSW, MSW, LCSW
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Telephone | 973-310-7120
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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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 #4
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Taxonomy Code | 174200000X
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Taxonomy Name | Meals Provider
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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