NPIMap

Organization Active NPI

Bridge Vision Licensed Clinical Social Worker

  • Community/Behavioral Health Agency
  • San Bernardino, CA
National Provider Identifier
1083069850
Registry record updated Oct 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
LCSW29187 Issued in CA
Legal business name
BRIDGE VISION LICENSED CLINICAL SOCIAL WORKER
Practice address
357 W 2ND St Ste 3
San Bernardino, CA 92401-1803
Phone
(909) 936-3888
Fax
(909) 635-6173
NPI assigned
Apr 29, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Colleen Nomsa Chali, PSYD, LCSWNPI 1912033747
Title
Clinical Director
Phone
(909) 936-3888

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X LCSW29187 CA Primary

Addresses

Primary practice location

357 W 2ND St Ste 3
San Bernardino, CA 92401-1803

Mailing address

255 N D St
Suite 401H
San Bernardino, CA 92401
Phone (909) 936-3888

National Provider Directory

National Provider Directory

Locations

357 W 2nd St
Ste 3
San Bernardino, CA 92401
Phone (909) 936-3888

255 N D St
Ste 401H
San Bernardino, CA 92401

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1461888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1571356800000",
    "number": "1083069850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "255 N D ST",
            "address_2": "SUITE 401H",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "92401",
            "telephone_number": "909-936-3888",
            "fax_number": "909-635-6173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "357 W 2ND ST STE 3",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924011803",
            "telephone_number": "909-936-3888",
            "fax_number": "909-635-6173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIDGE VISION LICENSED CLINICAL SOCIAL WORKER",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-29",
        "last_updated": "2019-10-18",
        "status": "A",
        "authorized_official_last_name": "CHALI",
        "authorized_official_first_name": "COLLEEN",
        "authorized_official_middle_name": "NOMSA",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "909-936-3888",
        "authorized_official_credential": "PSYD, LCSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "CA",
            "license": "LCSW29187",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Bernardino, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.