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General NPI Number Information
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NPI Number | 1386125946
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Entity Type | Individual
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Provider Name | BRIDGET JUANIQUE LARK LMFT
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Gender | Female
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Dates
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Enumeration Date | 08/22/2018
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Last Update Date | 09/29/2021
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Provider Practice Location Address
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Address Line | 600 SOMERDALE RD STE 101
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City | VOORHEES
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State | NJ
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Zip | 08043-1858
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Country | US
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Telephone | 856-656-9900
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Fax | 866-595-9377
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Provider Business Mailing Address
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Address Line | 38 WALNUT AVE
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City | LINDENWOLD
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State | NJ
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Zip | 08021-1635
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Country | US
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Telephone | 856-656-9900
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Fax | 856-595-9377
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 37FI00186600
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License Number State | NJ
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