Provider Demographics
NPI:1386125946
Name:LARK, BRIDGET JUANIQUE (LMFT)
Entity type:Individual
Prefix:MS
First Name:BRIDGET
Middle Name:JUANIQUE
Last Name:LARK
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:LINDENWOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:08021-1635
Mailing Address - Country:US
Mailing Address - Phone:856-656-9900
Mailing Address - Fax:856-595-9377
Practice Address - Street 1:600 SOMERDALE RD STE 101
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-1858
Practice Address - Country:US
Practice Address - Phone:856-656-9900
Practice Address - Fax:866-595-9377
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-22
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37FI00186600106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty