Organization
BRIDGE PSYCHOTHERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIDGET DOYLE- KUSY LCSW (OWNER/SOLE PROPRIETOR)
(860) 214-7439
Entity
Organization
Contact information
Practice address
47 MAIN ST, OLD MYSTIC, CT 06372-7700
(860) 214-7439
Mailing address
PO BOX 0562, BRIDGE PSYCHOTHERAPY, OLD MYSTIC, CT 06372
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
006035
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
006035
LCSW- LICENSE
CT
01
—
1306088984
INDIVIDUAL NPI
—
Enumeration date
01/16/2018
Last updated
01/16/2018
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