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General NPI Number Information
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NPI Number | 1255712394
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Entity Type | Organization
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Legal Business Name | BRIDGES TO SUCCESS LLC
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Dates
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Enumeration Date | 06/15/2015
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Last Update Date | 06/15/2015
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Provider Practice Location Address
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Address Line | 30 HAZEL TER SUITE C
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City | WOODBRIDGE
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State | CT
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Zip | 06525-2240
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Country | US
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Telephone | 203-296-0690
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Fax | 203-900-0690
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Provider Business Mailing Address
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Address Line | 1674 ELLA T GRASSO BLVD
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City | NEW HAVEN
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State | CT
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Zip | 06511-2802
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Country | US
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Telephone | 203-296-0690
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Fax | 203-900-0690
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Authorized Official
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Title or Position | THERAPIST
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Name | JUNE RODRIGUEZ
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Credential | LPC LADC SAP
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Telephone | 203-296-0690
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 000272
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 002456
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License Number State | CT
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