BRIDGE BACK TO LIFE CENTER, INC. (NPI# 1518918101) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1518918101 |
| Entity Type | Organization |
| Organization Name | BRIDGE BACK TO LIFE CENTER, INC. |
| Practice Address |
500 8th Ave Suite 906 New York NY 10018-6504 |
| Practice Telephone | 2126794960 |
| Practice Fax Number | 2126794966 |
| Mailing Telephone | 2126794960 |
| Mailing Fax Number | 2126794966 |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2009-02-12 |
| Authorized Official Name | MR. GARY BUTCHEN (PRESIDENT) |
| Authorized Official Telephone | 2126794960 |
| Authorized Official Credential | LCSW-R, SAP |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YM0800X |
Counselor Specialization: Mental Health |
Behavioral Health & Social Service Providers | ||
| N | 104100000X | Social Worker | Behavioral Health & Social Service Providers | ||
| N | 2084A0401X |
Psychiatry & Neurology Specialization: Addiction Medicine |
Allopathic & Osteopathic Physicians | ||
| N | 163WA0400X |
Registered Nurse Specialization: Addiction (Substance Use Disorder) |
Nursing Service Providers | ||
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790102051 | Bridge Back To Life Center, Inc. | Social Worker | 1688 Victory Blvd, Staten Island, NY 10314-3547 | 2014-03-25 |
| 1336566694 | Bridge Back To Life Center, Inc. | Registered Nurse | 175 Remsen St, Suite 1010, Brooklyn, NY 11201-4333 | 2014-03-25 |
| 1265859078 | Bridge Back To Life Center, Inc. | Registered Nurse | 4271 Hempstead Tpke, Bethpage, NY 11714-5708 | 2014-03-19 |
| 1184041998 | Bridge Back To Life Center, Inc. | Registered Nurse | 3044 Coney Island Ave, 3rd Floor, Brooklyn, NY 11235-5660 | 2014-03-19 |
| Street Address |
500 8TH AVE SUITE 906 |
| City | NEW YORK |
| State | NY |
| Zip Code | 10018-6504 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063960912 | Nirmala Brodman | Counselor | 500 8th Ave, 9th Floor, New York, NY 10018-6504 | 2016-09-20 |
| 1699223958 | Michael Cangro | Counselor | 500 8th Ave, New York, NY 10018-6504 | 2016-09-15 |
| 1730637000 | Adam Jason Coccaro | Counselor | 500 8th Ave, New York, NY 10018-6504 | 2016-09-15 |
| 1467811059 | Bridge Back To Life Center.inc | Community/Behavioral Health | 500 8th Ave, Suite 906, New York, NY 10018-6504 | 2016-02-11 |
| 1346626850 | Ginamarie Guarino | Counselor | 500 8th Ave, New York, NY 10018-6504 | 2015-08-06 |
| 1639555659 | Brian Kaveh | Counselor | 500 8th Ave, Suite 906, New York, NY 10018-6504 | 2015-07-31 |
| 1710360789 | Julio Lopez | Social Worker | 500 8th Ave, Suite 906, New York, NY 10018-6504 | 2015-07-08 |
| 1427438647 | Nicole Ogrady | Registered Nurse | 500 8th Ave, New York, NY 10018-6504 | 2015-06-03 |
| 1619374329 | Aynisa Leonardo | Clinical Ethicist | 500 8th Ave, New York, NY 10018-6504 | 2014-11-24 |
| 1992101034 | Kristina Cugini | Clinical Ethicist | 500 8th Ave, New York, NY 10018-6504 | 2014-11-18 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205451325 | Nishi Sanjay Patel | Physical Therapist | 12 West 37th Street, Suite 1202, New York, NY 10018 | 2020-06-15 |
| 1962023168 | Brand Therapy Psychological Services PC | Psychologist | 50 West 39th St, Suite 305, New York, NY 10018 | 2020-04-29 |
| 1215587985 | Nicole Kosanke | Psychologist | 519 8th Avenue, 9th Floor, New York, NY 10018 | 2019-09-16 |
| 1487216073 | Roselaure Luca | Nurse Practitioner | 5 Bryant Park, 5th Floor, New York, NY 10018 | 2019-07-03 |
| 1609439942 | Kamiyama Physical Therapy Pllc | Physical Therapist | 1410 Broadway Concourse Level, New York, NY 10018 | 2019-04-22 |
| 1609339126 | Bryan I. Proano | Social Worker | 550 10th Ave., New York, NY 10018 | 2019-04-11 |
| 1053876318 | Nitzia Mariana Dacosta | Registered Nurse | 505 8th Ave Suite 200, New York, NY 10018 | 2019-01-31 |
| 1871060640 | Jose Jean Paul Miliano | Case Manager/Care Coordinator | 535 Eighth Avenue. 2nd Floor, New York, NY 10018 | 2018-10-30 |
| 1902372220 | Stephanie Lai | Social Worker | 550 Tenth Avenue, New York, NY 10018 | 2018-10-15 |
| 1528554912 | Positive Health Project, Inc. | Counselor | 301 W 37th St Fl 3, New York, NY 10018 | 2018-07-09 |
| Find all providers in zip 10018 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
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| 1962018713 | The Dorm Lcsw, Pllc | Counselor | 175 W 72nd St Frnt 2, New York, NY 10023-3203 | 2020-09-17 |
| 1609481514 | John James Makohen | Counselor | Greenwish House Mmtp, 190 Mercer St, New York, NY 10012 | 2020-09-09 |
| 1942814595 | Anthony Mitchell Jr. | Counselor | 1090 Saint Nicholas Ave Frnt A, New York, NY 10032-3809 | 2020-09-01 |
| 1811517188 | Legacy House Inc | Counselor | 200 W 131st St Apt 10c, New York, NY 10027-2041 | 2020-04-16 |
| 1427695022 | Samuel Underwood | Counselor | 1727 Amsterdam Ave Fl 3, New York, NY 10031-4611 | 2019-12-03 |
| 1851954135 | Rebecca Forer | Counselor | 316 E 88th St Fl 3, New York, NY 10128-4909 | 2019-04-22 |
| 1043775380 | Jennisel A Marte | Counselor | 174 Nagle Ave Apt 31, New York, NY 10034-6039 | 2019-01-31 |
| 1215401195 | Anika Nakia Carter | Counselor | 192 Bradhurst Ave Apt 11, New York, NY 10039-1408 | 2019-01-14 |
| 1366913196 | Mavis H Baird | Counselor | 243 W 99th St #3e, New York, NY 10025 | 2018-12-05 |
| 1760958110 | Oren Mayo | Counselor | 116 E 92nd St Bsmt, New York, NY 10128-1620 | 2018-10-23 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.