Organization
BRIDGE BACK TO LIFE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARY BUTCHEN CASACLCSWR (EXECUTIVE DIREC TOR)
(212) 679-4960
Entity
Organization
Contact information
Practice address
4271 HEMPSTEAD TPKE, BETHPAGE, NY 11714-5708
(516) 520-6600
Mailing address
4271 HEMPSTEAD TPKE, BETHPAGE, NY 11714-5708
(516) 520-6600
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
003103
NY
Other
Enumeration date
07/22/2014
Last updated
07/22/2014
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