Organization
BRIDGE COUNSELING CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LISA F RAIA LCSW-R (PRESIDENT , DIRECTOR)
(631) 360-6695
Entity
Organization
Contact information
Practice address
269 E MAIN ST, SUITE F2, SMITHTOWN, NY 11787-2832
(631) 360-6695
Mailing address
PO BOX 286, SMITHTOWN, NY 11787-0286
(631) 360-6695
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
075024-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6020754230
—
NY
Enumeration date
06/22/2006
Last updated
07/20/2021
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