Provider Demographics
NPI:1366269706
Name:MCGOVERN, BRIDGET ELIZABETH (LCSW)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:ELIZABETH
Last Name:MCGOVERN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1443 E MOYAMENSING AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-6010
Mailing Address - Country:US
Mailing Address - Phone:267-275-7451
Mailing Address - Fax:
Practice Address - Street 1:525 S 4TH ST STE 363
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-1583
Practice Address - Country:US
Practice Address - Phone:267-225-5026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0243871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty