Provider Demographics
NPI:1104394287
Name:CANAL, BRIDGETTE IRENE (LMHC)
Entity type:Individual
Prefix:
First Name:BRIDGETTE
Middle Name:IRENE
Last Name:CANAL
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5408 N SEMINOLE AVE APT A
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33604-7031
Mailing Address - Country:US
Mailing Address - Phone:904-415-0734
Mailing Address - Fax:
Practice Address - Street 1:4312 N FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-3822
Practice Address - Country:US
Practice Address - Phone:813-421-3583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-07
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH20565101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health