=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497892244
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEW BRIDGE EMPLOYEES ASSISTANCE SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3601 HEMPSTEAD TURNPIKE STE LLM4
-----------------------------------------------------
City | LEVITTOWN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11756
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-713-1952
-----------------------------------------------------
Fax | 516-799-9655
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3601 HEMPSTEAD TURNPIKE STE LLM4
-----------------------------------------------------
City | LEVITTOWN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11756
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-713-1952
-----------------------------------------------------
Fax | 516-799-9655
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR LICENSED CLINICAL SOCIAL W
-----------------------------------------------------
Name | MR. ROBERT T HAZELTON
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 516-713-1952
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | R034583
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------