Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Bridge Back to Life Center, Inc

Organization Clinical Social Worker · NPI 1790102051

Bridge Back to Life Center, Inc is a Clinical Social Worker in Staten Island, New York. Licensed in New York. Registered with an NPI since 2014.

Licensed in
NY
In the registry since
2014
What do these letters mean?
Inc — Incorporated
A form of business registration, not a clinical qualification.

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Practice location Address checks out

1688 Victory Blvd
Staten Island, NY 10314-3547
Phone: (718) 447-5700
Fax: (718) 442-8945
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence 141110677 (NY)

Record details

NPI number1790102051
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Gary Butchen — President · (516) 520-6600
NPI enumeratedMarch 25, 2014
Last updated in NPPESNovember 7, 2018
Mailing address4271 Hempstead Tpke, Bethpage, NY 11714-5708

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