Basic Information
| Provider Information | |||||||||
| NPI: | 1851816060 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BRIDGEVIEW PSYCHOLOGICAL SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1514 | ||||||||
| Address2: | |||||||||
| City: | BENICIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945104514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7078160963 | ||||||||
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| Practice Location | |||||||||
| Address1: | 701 SOUTHAMPTON RD STE 209F | ||||||||
| Address2: | |||||||||
| City: | BENICIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945102055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7078160963 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | SEAY DASHJIAN | ||||||||
| AuthorizedOfficialFirstName: | LAUREN | ||||||||
| AuthorizedOfficialMiddleName: | TRACEY | ||||||||
| AuthorizedOfficialTitleorPosition: | PSYCHOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 5599304695 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PH.D. | ||||||||
| NPICertificationDate: | 06/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC1900X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Counseling |
No ID Information.