LIFEBRIDGE COMMUNITY SERVICES, INC. (NPI# 1922006923) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1922006923 |
| Entity Type | Organization |
| Organization Name | LIFEBRIDGE COMMUNITY SERVICES, INC. |
| Other Organization Name | FSW, INC |
| Practice Address |
475 Clinton Ave Bridgeport CT 06605-1700 |
| Practice Telephone | 2033684291 |
| Practice Fax Number | 2033689167 |
| Mailing Telephone | 2033684291 |
| Mailing Fax Number | 2033689167 |
| Enumeration Date | 2005-07-13 |
| Last Update Date | 2015-07-07 |
| Authorized Official Name | DR. WILLIAM J HASS (PRESIDENT & CEO) |
| Authorized Official Telephone | 2033685552 |
| Authorized Official Credential | PH.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
Ambulatory Health Care Facilities | ||
| Y | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
CT | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CT | 004069985 | 05 |
| Other Name | Type Code |
|---|---|
| FSW, Inc | Former Legal Business Name - Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Connecticut Business Registrations | LIFEBRIDGE COMMUNITY SERVICES, INC. |
| Street Address |
475 CLINTON AVE |
| City | BRIDGEPORT |
| State | CT |
| Zip Code | 06605-1700 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538721311 | Tamara Corley | Social Worker | 475 Clinton Ave, Bridgeport, CT 06605-1700 | 2019-07-02 |
| 1265099253 | Marcos Rosa | Marriage & Family Therapist | 475 Clinton Ave, Bridgeport, CT 06605-1700 | 2019-05-24 |
| 1619432267 | Vanessa Jaunai | Counselor | 475 Clinton Ave, Bridgeport, CT 06605-1700 | 2019-02-07 |
| 1225508229 | Silvia Dicovich | Counselor | 475 Clinton Ave, Bridgeport, CT 06605-1700 | 2018-12-03 |
| 1316415557 | Elena Cela | Counselor | 475 Clinton Ave, Bridgeport, CT 06605-1700 | 2018-11-06 |
| 1497223887 | Kenyatta Tolbert | Social Worker | 475 Clinton Ave, Bridgeport, CT 06605-1700 | 2018-11-05 |
| 1710454509 | Emilia Hodel | Counselor | 475 Clinton Ave, Bridgeport, CT 06605-1700 | 2018-10-30 |
| 1861970949 | Marlene M Wolf | Marriage & Family Therapist | 475 Clinton Ave, Bridgeport, CT 06605-1700 | 2018-08-01 |
| 1982180899 | Jian Shen | Counselor | 475 Clinton Ave, Bridgeport, CT 06605-1700 | 2018-07-13 |
| 1073009320 | Stacey L Casparius | Marriage & Family Therapist | 475 Clinton Ave, Bridgeport, CT 06605-1700 | 2018-07-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497312276 | Stacy-ann Thompson-grant | Social Worker | 170 Bennet T Street, Bridgeport, CT 06605 | 2019-05-28 |
| 1720502149 | Sheree Amankwah | Counselor | 170 Bennett Street, Bridgeport, CT 06605 | 2017-07-27 |
| 1417477324 | Aracelis Robertson | Case Manager/Care Coordinator | 1646 Fairfield Avenue, 3rd Floor, Bridgeport, CT 06605 | 2017-06-21 |
| 1699158170 | Cortney Davis | Physician Assistant | 3250 Fairfield Ave, Unit 217, Bridgeport, CT 06605 | 2015-07-02 |
| 1083020051 | Douglas Mccoy | Nurse Practitioner | 46 Albion St., Bridgeport, CT 06605 | 2014-07-10 |
| 1932513785 | Hallie Claire Riggs | Social Worker | 1730 State St Ext, Bridgeport, CT 06605 | 2014-06-19 |
| 1831518513 | Yvonne Booy | Counselor | 46 Albion Street, Bridgeport, CT 06605 | 2014-04-10 |
| 1760556955 | Joel W Allen | Obstetrics & Gynecology | 625 Clinton Ave, Bridgeport, CT 06605 | 2006-11-20 |
| 1316046428 | Allen P Schlein | Orthopaedic Surgery | 650 Clinten Avenue, Bridgeport, CT 06605 | 2006-09-22 |
| 1336127984 | Hancock Pharmacy | Pharmacy | 1557 Fairfield Ave, Bridgeport, CT 06605 | 2006-01-04 |
| Find all providers in zip 06605 | ||||
| Taxonomy Code | 261QM0801X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Mental Health (Including Community Mental Health Center) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194069708 | Connecticut Renaissance, Inc. | Clinic/Center | 1126 Main St, Bridgeport, CT 06604-4404 | 2012-11-20 |
| 1316158256 | Chemical Abuse Services Agency, Inc. | Clinic/Center | 592 Kossuth St, Bridgeport, CT 06608-2204 | 2007-05-24 |
| 1225247224 | Chemical Abuse Services Agency, Inc. | Clinic/Center | 690 Arctic St, Bridgeport, CT 06608-2008 | 2007-05-22 |
| 1669537668 | Jewish Family Service, Inc. | Clinic/Center | 2370 Park Ave, Bridgeport, CT 06604-1617 | 2006-12-27 |
| 1770145286 | Cathartic Breakthroughs, LLC | Clinic/Center | 1000 Lafayette Blvd, Bridgeport, CT 06604-4725 | 2019-07-03 |
| 1023675873 | South- West Community Health Center, Inc | Clinic/Center | 1046 Fairfield Ave, Bridgeport, CT 06605-1116 | 2019-05-28 |
| 1518181965 | Catholic Charities of Fairfield County, Inc. | Clinic/Center | 238 Jewett Ave, Bridgeport, CT 06606-2845 | 2007-04-13 |
| 1720130362 | Connecticut Renaissance, Inc. | Clinic/Center | 1 Lafayette Cir, Bridgeport, CT 06604-6021 | 2007-01-16 |
| 1992871875 | Optimus Health Care | Clinic/Center | 471 Barnum Ave, Bridgeport, CT 06608-2409 | 2006-11-24 |
| 1699703686 | South- West Community Health Center, Inc | Clinic/Center | 46 Albion St, Bridgeport, CT 06605-2602 | 2006-06-29 |
| Find all providers in BRIDGEPORT | ||||
| City | BRIDGEPORT |
| Zip Code | 06605 |
Please comment or provide details below to improve the information on LIFEBRIDGE COMMUNITY SERVICES, INC..
| 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.