Provider Demographics
NPI:1316512205
Name:BRIDGE, RAINA E (LCSW)
Entity type:Individual
Prefix:
First Name:RAINA
Middle Name:E
Last Name:BRIDGE
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 1:11306 JOLIET ST
Mailing Address - Street 2:
Mailing Address - City:COMMERCE CITY
Mailing Address - State:CO
Mailing Address - Zip Code:80640-7663
Mailing Address - Country:US
Mailing Address - Phone:303-913-8925
Mailing Address - Fax:
Practice Address - Street 1:10465 MELODY DR STE 209
Practice Address - Street 2:
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80234-4125
Practice Address - Country:US
Practice Address - Phone:303-913-8925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-24
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099250301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical