Organization
BRIDGE BACK TO LIFE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KATHRYN MARIE RYAN LMSW (STAFF THERAPIST)
(718) 447-5700
Entity
Organization
Contact information
Practice address
1688 VICTORY BLVD, STATEN ISLAND, NY 10314-3533
(718) 447-5700
Mailing address
1688 VICTORY BLVD, STATEN ISLAND, NY 10314-3533
(718) 447-5700
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
080531
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080531
KATHRYN MARIE RYAN
NY
Enumeration date
01/19/2010
Last updated
01/19/2010
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