NPIMap

Organization Active NPI

Bridge Back to Life Inc

  • Mental Health Counselor
  • Bethpage, NY
National Provider Identifier
1194132175
Registry record updated Jul 22, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
003103 Issued in NY
Legal business name
BRIDGE BACK TO LIFE INC
Practice address
4271 Hempstead Tpke
Bethpage, NY 11714-5708
Phone
(516) 520-6600
NPI assigned
Jul 22, 2014
Last updated
Jul 22, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2014

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

Authorized official

Name
Gary Butchen, CASACLCSWR
Title
Executive Direc Tor
Phone
(212) 679-4960

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 003103 NY Primary

Addresses

Primary practice location

4271 Hempstead Tpke
Bethpage, NY 11714-5708

Mailing address

4271 Hempstead Tpke
Bethpage, NY 11714-5708
Phone (516) 520-6600

National Provider Directory

National Provider Directory
Tax ID family
Bridge Back to Life Center Inc14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

Organizations that report the same tax identification number in the National Provider Directory.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1405987200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1405987200000",
    "number": "1194132175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4271 HEMPSTEAD TPKE",
            "city": "BETHPAGE",
            "state": "NY",
            "postal_code": "117145708",
            "telephone_number": "516-520-6600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4271 HEMPSTEAD TPKE",
            "city": "BETHPAGE",
            "state": "NY",
            "postal_code": "117145708",
            "telephone_number": "516-520-6600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIDGE BACK TO LIFE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-22",
        "last_updated": "2014-07-22",
        "status": "A",
        "authorized_official_last_name": "BUTCHEN",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "EXECUTIVE DIREC TOR",
        "authorized_official_telephone_number": "212-679-4960",
        "authorized_official_credential": "CASACLCSWR"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NY",
            "license": "003103",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bethpage, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2014; 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.