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NPI Code Detail

MEDICARE: MRS. ALICIA BRIDGRAJ LMSW

MEDICARE:  MRS. ALICIA  BRIDGRAJ  LMSW
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
1104100000XSocial Worker086251NY

General Provider Information

NPI Number : 1790117091
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ALICIA BRIDGRAJ LMSW
Provider Business Mailing Address
First Line : 160 BEACH 117TH ST
Second Line : APT 5B
City : ROCKAWAY PARK
State : NY
Zip : 11694-2041
Country : US
Telephone Number : 917-293-2506
Fax Number :
Provider Business Practice Location Address
First Line : 160 BEACH 117TH ST
Second Line : APT 5B
City : ROCKAWAY PARK
State : NY
Zip : 11694-2041
Country : US
Telephone Number : 917-293-2506
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2013
Last Update Date : 08/08/2013

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Directions to “ MRS. ALICIA BRIDGRAJ LMSW” Practice Location

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