Provider Demographics
NPI:1306088984
Name:DOYLE-KUSY, BRIDGET R (LCSW)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:R
Last Name:DOYLE-KUSY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 MAIN ST UNIT 562
Mailing Address - Street 2:
Mailing Address - City:OLD MYSTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06372-7718
Mailing Address - Country:US
Mailing Address - Phone:860-214-7439
Mailing Address - Fax:
Practice Address - Street 1:47 MAIN ST 2ND FLOOR
Practice Address - Street 2:
Practice Address - City:OLD MYSTIC
Practice Address - State:CT
Practice Address - Zip Code:06372
Practice Address - Country:US
Practice Address - Phone:860-214-7439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-30
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0060351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD400003178 - C00814Medicare PIN