| Organization Name: | CLINICAL BRIDGE |
| NPI Number: | 1235463845 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JONATHAN F. MICHAELIS (PRESIDENT) |
| Mailing Address: | 209 Main St Southington |
| State: | CT US |
| Postal Code: | 064892539 |
| Phone Number: | 2032162036 |
| Fax Number: | |
| NPI Enumeration Date: | 09/29/2009 |
| NPI Last Update Date: | 09/29/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC2200X |
| License Number: | 001477 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical Child & Adolescent |
| Taxonomy Definition: | |