Provider Demographics
NPI:1699137737
Name:HEALTH BRIDGE NEWPORT
Entity type:Organization
Organization Name:HEALTH BRIDGE NEWPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:NICK
Authorized Official - Last Name:CUSHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-715-9321
Mailing Address - Street 1:20072 SW BIRCH ST
Mailing Address - Street 2:SUITE 240
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-0794
Mailing Address - Country:US
Mailing Address - Phone:949-715-9321
Mailing Address - Fax:310-300-0306
Practice Address - Street 1:20072 SW BIRCH ST
Practice Address - Street 2:SUITE 240
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-0794
Practice Address - Country:US
Practice Address - Phone:949-715-9321
Practice Address - Fax:310-300-0306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-28
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND-145102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalystGroup - Multi-Specialty