Provider Demographics
NPI:1982449880
Name:BARD-WIGDOR, BRACHA
Entity type:Individual
Prefix:
First Name:BRACHA
Middle Name:
Last Name:BARD-WIGDOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:587 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:HILLSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07205-3117
Mailing Address - Country:US
Mailing Address - Phone:718-360-6273
Mailing Address - Fax:
Practice Address - Street 1:72 EASTBOURNE DR
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-6403
Practice Address - Country:US
Practice Address - Phone:718-360-6273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker