BRIDGE BACK TO LIFE CENTER INC. NPI 1184041998

NPI Information

  • NPI: 1184041998
  • Provider Name: BRIDGE BACK TO LIFE CENTER, INC.
  • Classification: Social Worker - 1041C0700X
  • Specialization: Clinical
  • Entity Type: Organization
  • Address: 3044 CONEY ISLAND AVE
    3RD FLOOR
    BROOKLYN, NY
    ZIP 11235
  • Phone: (718) 265-4200

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NPI Details

BRIDGE BACK TO LIFE CENTER, INC. is a clinical social worker in Brooklyn, NY. The provider is 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. BRIDGE BACK TO LIFE CENTER, INC. NPI is 1184041998. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

3044 CONEY ISLAND AVE
3RD FLOOR
BROOKLYN, NY
ZIP 11235-660
Phone: (718) 265-4200
Fax: (718) 265-8536

The provider's authorized official is Gary Butchen .
The authorized official title is President and has the following contact phone number (516) 520-6600.

The enumeration date for this NPI number is 3/19/2014 and was last updated on 11/7/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1163WA0400XRegistered NurseAddiction (Substance Use Disorder)141111254NEW YORKNo
21041C0700XSocial WorkerClinical141111254NEW YORKYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
101439087MEDICAIDNEW YORK

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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