Provider Demographics
NPI:1124130448
Name:HARRISON, BRIDGET MARY (PHD, HSPP, BCBA)
Entity type:Individual
Prefix:DR
First Name:BRIDGET
Middle Name:MARY
Last Name:HARRISON
Suffix:
Gender:F
Credentials:PHD, HSPP, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 GEORGIA ST
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-6227
Mailing Address - Country:US
Mailing Address - Phone:219-791-1400
Mailing Address - Fax:219-791-1422
Practice Address - Street 1:8200 GEORGIA ST
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6227
Practice Address - Country:US
Practice Address - Phone:219-791-1400
Practice Address - Fax:219-791-1422
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1-08-4182103K00000X
IN20041444A103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN793670000OtherMAGELLAN
IN000000392067OtherANTHEM BC/BS
IN11379616OtherCAQH
IN200429240Medicaid
IN200462360Medicaid
IN248100AMedicare PIN