Provider Demographics
NPI:1679467658
Name:SMITH, BRIDGET (LAC)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:
Last Name:SMITH
Suffix:
Gender:X
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:G9 SHIRLEY LN
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-1424
Mailing Address - Country:US
Mailing Address - Phone:609-474-0412
Mailing Address - Fax:
Practice Address - Street 1:166 BUNN DRIVE
Practice Address - Street 2:STE 107
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-2800
Practice Address - Country:US
Practice Address - Phone:609-474-0412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-05
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00656300101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health