# BRIDGE BACK TO LIFE CENTER, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1518918101
- **Authorized official:** ELIZABETH CARUCCI ROSSI (BILLING SUPERVISOR)
- **Authorized official phone:** (516) 520-6600

## Contact information

- **Practice address:** 1065 STEWART AVE STE 101, BETHPAGE, NY 11714-3637
- **Practice address phone:** (516) 520-6600
- **Practice address fax:** (516) 520-6750
- **Mailing address:** 1065 STEWART AVE STE 101, BETHPAGE, NY 11714-3637
- **Mailing address phone:** (516) 520-6600
- **Mailing address fax:** (516) 520-6750

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 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 | — | NULL | Yes |

## Other

- **Enumeration date:** 05/16/2006
- **Last updated:** 07/22/2024