Doctor Name: | BRIDGET MODICA |
NPI Number: | 1467584458 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 8681 Wesleyan Dr Apt. 6-19 Fort Myers, FL - 339195260 |
Business Phone Number: | 2397287976 |
Business Fax Number: | 2392363597 |
Mailing Address: | 8681 Wesleyan Dr, Apt. 6-19 FORT MYERS |
State: | FL |
Postal Code: | 339195260 |
Phone Number: | 2397287976 |
Fax Number: | 2392363597 |
NPI Enumeration Date: | 03/12/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |