Provider Demographics
NPI:1386292183
Name:VAHER, BRIDGET (LMSW)
Entity type:Individual
Prefix:MS
First Name:BRIDGET
Middle Name:
Last Name:VAHER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:394A LENOX ROAD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746
Mailing Address - Country:US
Mailing Address - Phone:631-813-9403
Mailing Address - Fax:
Practice Address - Street 1:1444 5TH AVENUE
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706
Practice Address - Country:US
Practice Address - Phone:631-650-0115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-27
Last Update Date:2019-10-18
Deactivation Date:2019-08-28
Deactivation Code:
Reactivation Date:2019-10-14
Provider Licenses
StateLicense IDTaxonomies
NY106554-012255A2300X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer