| Lisa G. Bridgewater, Ph.d. Pa | |
|
229 Johnston St Rock Hill SC 29730-3579 | |
| (803) 517-0322 | |
| (803) 328-1866 |
| Full Name | Lisa G. Bridgewater, Ph.d. Pa |
|---|---|
| Speciality | Psychologist |
| Location | 229 Johnston St, Rock Hill, South Carolina |
| Authorized Official Name and Position | Lisa Bridgewater (PRESIDENT) |
| Authorized Official Contact | 8035170322 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lisa G. Bridgewater, Ph.d. Pa Po Box 828 Chester SC 29706-0828 Ph: (803) 517-0322 | Lisa G. Bridgewater, Ph.d. Pa 229 Johnston St Rock Hill SC 29730-3579 Ph: (803) 517-0322 |
| NPI Number | 1699105882 |
|---|---|
| Provider Enumeration Date | 11/25/2013 |
| Last Update Date | 11/25/2013 |
| Medicare PECOS PAC ID | 9830313758 |
|---|---|
| Medicare Enrollment ID | O20140617000231 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699105882 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
| Provider Name | Lisa Grey Bridgewater |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1366403081 PECOS PAC ID: 8022105188 Enrollment ID: I20071106000532 |
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