| Bridge the Gap Aba | |
|
15 Newman St Patchogue NY 11772-1118 | |
| (631) 312-0523 | |
| Not Available |
| Full Name | Bridge the Gap Aba |
|---|---|
| Speciality | Behavior Analyst |
| Location | 15 Newman St, Patchogue, New York |
| Authorized Official Name and Position | Jeanne Mac Donald (GENERAL PARTNEWR) |
| Authorized Official Contact | 6313120523 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bridge the Gap Aba 15 Newman St Patchogue NY 11772-1118 Ph: (631) 312-0523 | Bridge the Gap Aba 15 Newman St Patchogue NY 11772-1118 Ph: (631) 312-0523 |
| NPI Number | 1831791433 |
|---|---|
| Provider Enumeration Date | 11/10/2020 |
| Last Update Date | 11/10/2020 |
| Certification Date | 11/10/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831791433 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (NU) | Primary |
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