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General NPI Number Information
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NPI Number | 1265638597
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Entity Type | Individual
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Provider Name | VICTORIA ENNIS BRIDGES LCSW
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Gender | Female
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Dates
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Enumeration Date | 06/24/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 400 FORT HILL AVE
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City | CANANDAIGUA
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State | NY
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Zip | 14424-1159
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Country | US
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Telephone | 585-393-7770
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Fax |
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Provider Business Mailing Address
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Address Line | 5563 CENTERPOINTE BLVD APT. 6
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City | CANANDAIGUA
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State | NY
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Zip | 14424-7832
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Country | US
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Telephone | 585-394-8077
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 2001031824
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License Number State | MO
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