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
—
—
101YM0800X
Mental Health Counselor
—
—
104100000X
Social Worker
—
—
163WA0400X
Addiction (Substance Use Disorder) Registered Nurse
—
—
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
05/16/2006
Last updated
07/22/2024
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