Organization
BRIDGE BACK TO LIFE CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARY BUTCHEN LCSW-R, SAP (PRESIDENT)
(516) 520-6600
Entity
Organization
Contact information
Practice address
3044 CONEY ISLAND AVE, 3RD FLOOR, BROOKLYN, NY 11235-5660
(718) 265-4200
(718) 265-8536
Mailing address
4271 HEMPSTEAD TPKE, BETHPAGE, NY 11714-5708
(516) 520-6600
(516) 520-6750
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
141111254
NY
163WA0400X
Addiction (Substance Use Disorder) Registered Nurse
141111254
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01439087
—
NY
Enumeration date
03/19/2014
Last updated
11/07/2018
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