Provider Demographics
NPI:1306436704
Name:HENNESSEY, BRIDGET BAKER (MA)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:BAKER
Last Name:HENNESSEY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:BAKER
Other - Last Name:BERGSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:655 STATE RD STE 208
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:MA
Mailing Address - Zip Code:02790-2864
Mailing Address - Country:US
Mailing Address - Phone:508-715-9519
Mailing Address - Fax:
Practice Address - Street 1:655 STATE RD STE 208
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:MA
Practice Address - Zip Code:02790-2864
Practice Address - Country:US
Practice Address - Phone:508-715-9519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-20
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health