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Organization
BRIDGE BACK TO LIFE CENTER, INC.
Active
Organization
BRIDGE BACK TO LIFE CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH CARUCCI ROSSI (BILLING SUPERVISOR)
(516) 520-6600
Entity
Organization
Contact information
Practice address
1065 STEWART AVE STE 101, BETHPAGE, NY 11714-3637
(516) 520-6600
(516) 520-6750
Mailing address
1065 STEWART AVE STE 101, BETHPAGE, NY 11714-3637
(516) 520-6600
(516) 520-6750
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
NULL
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
NULL
101YM0800X
Mental Health Counselor
—
—
104100000X
Social Worker
—
NULL
104100000X
Social Worker
—
—
163WA0400X
Addiction (Substance Use Disorder) Registered Nurse
—
NULL
163WA0400X
Addiction (Substance Use Disorder) Registered Nurse
—
—
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
—
NULL
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
NULL
Other
Enumeration date
05/16/2006
Last updated
07/22/2024
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