Active NPI
Janice G. Bridgewater, LCSW
- Counselor
- Portland, OR
National Provider Identifier
1962555714
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- L3788
- Practice address
- 1235 SE Division #104
Portland, OR 97202 - Phone
- (503) 888-9540
- NPI assigned
- Jan 18, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 3788 | OR | |
| Counselor | 101Y00000X | L3788 | OR | Primary |
Addresses
Primary practice location
1235 SE Division #104
Portland, OR 97202
Mailing address
1235 SE Division #104
Portland, OR 97202
Phone (503) 888-9540
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3788 | OR | MD | Counselor |
| L3788 | OR | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169078400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1662422400000",
"number": "1962555714",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1235 SE DIVISION #104",
"city": "PORTLAND",
"state": "OR",
"postal_code": "97202",
"telephone_number": "503-888-9540"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1235 SE DIVISION #104",
"city": "PORTLAND",
"state": "OR",
"postal_code": "97202",
"telephone_number": "503-888-9540"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRIDGEWATER",
"first_name": "JANICE",
"middle_name": "G.",
"name_prefix": "Ms.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-18",
"last_updated": "2022-09-06",
"certification_date": "2022-09-06",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "OR",
"license": "3788",
"primary": false
},
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "OR",
"license": "L3788",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.