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General NPI Number Information
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NPI Number | 1427566645
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Entity Type | Organization
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Legal Business Name | BRIDGE OF LOVE II LLC
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Dates
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Enumeration Date | 01/22/2018
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Last Update Date | 02/14/2024
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Provider Practice Location Address
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Address Line | 331 MARGATE RD
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City | UPPER DARBY
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State | PA
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Zip | 19082-4613
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Country | US
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Telephone | 484-424-6629
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Fax |
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Provider Business Mailing Address
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Address Line | 18 CAMPUS BLVD STE 100
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City | NEWTOWN SQUARE
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State | PA
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Zip | 19073-3240
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Country | US
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Telephone | 484-423-3426
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Fax | 484-423-3401
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | BRIDGETTE MONTGOMERY
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Credential | DSW MSW LCSW MSNPM
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Telephone | 267-206-8762
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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 |
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License Number State |
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