BRIDGE BACK TO LIFE CENTER, INC. (NPI# 1790102051) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790102051 |
| Entity Type | Organization |
| Organization Name | BRIDGE BACK TO LIFE CENTER, INC. |
| Practice Address |
1688 Victory Blvd Staten Island NY 10314-3547 |
| Mailing Address |
4271 Hempstead Tpke Bethpage NY 11714-5708 |
| Practice Telephone | 7184475700 |
| Practice Fax Number | 7184428945 |
| Mailing Telephone | 5165206600 |
| Mailing Fax Number | 5165206750 |
| Enumeration Date | 2014-03-25 |
| Last Update Date | 2018-11-07 |
| Authorized Official Name | MR. GARY BUTCHEN (PRESIDENT) |
| Authorized Official Telephone | 5165206600 |
| Authorized Official Credential | LCSW-R, SAP |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1041C0700X |
Social Worker Specialization: Clinical |
141110677 | NY | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | 01439087 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336566694 | Bridge Back To Life Center, Inc. | Registered Nurse | 175 Remsen St, Suite 1010, Brooklyn, NY 11201-4333 | 2014-03-25 |
| 1265859078 | Bridge Back To Life Center, Inc. | Registered Nurse | 4271 Hempstead Tpke, Bethpage, NY 11714-5708 | 2014-03-19 |
| 1184041998 | Bridge Back To Life Center, Inc. | Registered Nurse | 3044 Coney Island Ave, 3rd Floor, Brooklyn, NY 11235-5660 | 2014-03-19 |
| 1518918101 | Bridge Back To Life Center, Inc. | Counselor | 500 8th Ave, Suite 906, New York, NY 10018-6504 | 2006-05-16 |
| Street Address |
1688 VICTORY BLVD |
| City | STATEN ISLAND |
| State | NY |
| Zip Code | 10314-3547 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578645735 | Marina Chernyak | Social Worker | 1688 Victory Blvd, Staten Island, NY 10314-3533 | 2006-10-19 |
| 1508490889 | Shannon Rick | Social Worker | 1688 Victory Blvd, Staten Island, NY 10314-3547 | 2020-02-26 |
| 1982188256 | Nia Braithwaite | Student in an Organized Health Care Education/Training Program | 1688 Victory Blvd, Staten Island, NY 10314-3547 | 2018-09-21 |
| 1255881918 | Alexa Accardi | Counselor | 1688 Victory Blvd, Staten Island, NY 10314-3547 | 2016-10-06 |
| 1770030660 | Vanessa Barulich | Counselor | 1688 Victory Blvd, Staten Island, NY 10314-3547 | 2016-09-08 |
| 1194272138 | Amanda Jill Cloninger | Social Worker | 1688 Victory Blvd, Staten Island, NY 10314-3547 | 2016-09-07 |
| 1790230282 | Jeffrey Whitney | Counselor | 1688 Victory Blvd, Staten Island, NY 10314-3547 | 2016-08-24 |
| 1124403241 | Janice Kowalski | Social Worker | 1688 Victory Blvd, Staten Island, NY 10314-3547 | 2015-07-30 |
| 1346626488 | George Vega | Counselor | 1688 Victory Blvd, Staten Island, NY 10314-3547 | 2015-07-30 |
| 1811235716 | Dennis Meagher | Counselor | 1688 Victory Blvd, Staten Island, NY 10314-3547 | 2013-01-28 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568076255 | Edward Leccese | Massage Therapist | 77 Renee Place, Staten Island, NY 10314 | 2020-09-01 |
| 1871154633 | Matthew Richard Puliatti | Counselor | 1688 Victory Boulevard, Staten Island, NY 10314 | 2019-06-24 |
| 1750845137 | Miriam Gordon Pediatric Np PC | Nurse Practitioner | 7 Ismay Street, Staten Island, NY 10314 | 2019-01-30 |
| 1003391186 | 2791 Richmond LLC | Dentist | 2791 Richmond Avenue, Suite 2, Staten Island, NY 10314 | 2018-09-25 |
| 1477046522 | Miriam A Madry | Optometrist | 569 Woolley Ave, Staten Island, NY 10314 | 2018-06-13 |
| 1174025894 | Staten Island Dentistry P.C. | Clinic/Center | 979 Willowbrook Rd., Staten Island, NY 10314 | 2018-03-08 |
| 1205335023 | Ashley Larsen | Early Intervention Provider Agency | 229 Wellington Ct, Staten Island, NY 10314 | 2018-02-07 |
| 1306369699 | Victoria Ali | Behavior Technician | 228 Melvin Avenue, Staten Island, NY 10314 | 2017-07-19 |
| 1700307360 | Lydia Mora | Specialist | 2025 Richmond Avenue Suite 200, Staten Island, NY 10314 | 2017-07-03 |
| 1366971707 | Lisa Pietracatella | Massage Therapist | 92 Margaretta Court, Staten Island, NY 10314 | 2017-06-08 |
| Find all providers in zip 10314 | ||||
| Taxonomy Code | 1041C0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Social Worker |
| Specialization | Clinical |
| A social worker who holds a master’s or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master’s supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances. |
| Notes: Source: National Association of Social Workers, 2008 [7/1/2009: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649871781 | Samantha Rizzo-bohsali | Social Worker | 20 Clermont Pl, Staten Island, NY 10314-4020 | 2020-11-05 |
| 1770197543 | Robin E Fenley | Social Worker | 223 Mountainview Ave, Staten Island, NY 10314-5315 | 2020-08-31 |
| 1598378341 | Lori Beth Howe | Social Worker | 69 Maine Ave, Staten Island, NY 10314-2316 | 2020-08-30 |
| 1518581487 | Stephen Krysztoforski | Social Worker | 51 Alverson Loop, Staten Island, NY 10309-1748 | 2020-06-05 |
| 1720601743 | Mary L Williams | Social Worker | 693 Pelton Ave, Staten Island, NY 10310-3139 | 2020-05-26 |
| 1316585979 | Cassandra Lauletti | Social Worker | 88 New Dorp Plz S Ste 203, Staten Island, NY 10306-2902 | 2019-12-13 |
| 1427602846 | Mc Queen and Otuyelu Lcsw Wellness | Social Worker | 941 Forest Avenue, Staten Island, NY 10310 | 2019-07-25 |
| 1326601709 | Bruce Monteleon | Social Worker | 173 Maine Avenue, Staten Island, NY 10314-1031 | 2019-04-21 |
| 1407331218 | Cassedy Jene Rymer | Social Worker | 105 Hamilton Ave Rm 116, Staten Island, NY 10301-1610 | 2018-09-27 |
| 1720561996 | Yazmin Iris Perez | Social Worker | 358 Saint Marks Pl Fl 4, Staten Island, NY 10301-2417 | 2018-09-12 |
| Find all providers in STATEN ISLAND | ||||
| City | STATEN ISLAND |
| Zip Code | 10314 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.