MEDICARE: BRIDGED THERAPY FOR SENIORS

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

General Provider Information

NPI Number	:	1356110647
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIDGED THERAPY FOR SENIORS

Provider Business Mailing Address
First Line	:	9 NORTH DURHAM DRIVE
Second Line	:
City	:	HOWELL TOWNSHIP
State	:	NJ
Zip	:	07731
Country	:	US
Telephone Number	:	818-900-3957
Fax Number	:

Provider Business Practice Location Address
First Line	:	9 NORTH DURHAM DRIVE
Second Line	:
City	:	HOWELL TOWNSHIP
State	:	NJ
Zip	:	07731
Country	:	US
Telephone Number	:	818-900-3957
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RIVKA GERSON
Credential	:	LCSW
Telephone Number	:	818-900-3957

Provider Enumeration Date	:	12/27/2023
Last Update Date	:	09/18/2024

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