MEDICARE: BRIDGES PSYCHOLOGICAL SERVICES, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker
2	103TC0700X	Clinical Psychologist	014325	NY

General Provider Information

NPI Number	:	1154870368
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIDGES PSYCHOLOGICAL SERVICES, P.C.

Provider Business Mailing Address
First Line	:	2747 CONEY ISLAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-5004
Country	:	US
Telephone Number	:	917-586-5652
Fax Number	:

Provider Business Practice Location Address
First Line	:	2747 CONEY ISLAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-5004
Country	:	US
Telephone Number	:	917-586-5652
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. ROBERT M MORRISON
Credential	:	PSY.D.
Telephone Number	:	908-377-3105

Provider Enumeration Date	:	09/28/2016
Last Update Date	:	10/20/2016

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