Provider Demographics
NPI:1427128750
Name:BRIDGE YOUTH & FAMILY SERVICES
Entity type:Organization
Organization Name:BRIDGE YOUTH & FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:D
Authorized Official - Last Name:CUNNEEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-359-7490
Mailing Address - Street 1:721 S QUENTIN RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067-6778
Mailing Address - Country:US
Mailing Address - Phone:847-359-7490
Mailing Address - Fax:847-359-7525
Practice Address - Street 1:721 S QUENTIN RD
Practice Address - Street 2:SUITE 103
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-6778
Practice Address - Country:US
Practice Address - Phone:847-359-7490
Practice Address - Fax:847-359-7525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL026714-11251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health