MEDICARE: BRIDGETTE CROWELL IBCLC

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	174N00000X	Lactation Consultant (Non-RN)	L-316928	NY

General Provider Information

NPI Number	:	1225970338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIDGETTE CROWELL IBCLC

Provider Business Mailing Address
First Line	:	136 NEWTON ST APT B1
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11222-0474
Country	:	US
Telephone Number	:	661-600-3080
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 DEAN ST STE 347
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11238-3385
Country	:	US
Telephone Number	:	646-450-0875
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2026
Last Update Date	:	04/07/2026

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