Provider Demographics
NPI:1710373980
Name:BRIDENDOLPH, NATHAN JR (PHD)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:
Last Name:BRIDENDOLPH
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4886 HYDE RD
Mailing Address - Street 2:
Mailing Address - City:MANLIUS
Mailing Address - State:NY
Mailing Address - Zip Code:13104-9410
Mailing Address - Country:US
Mailing Address - Phone:301-991-1712
Mailing Address - Fax:
Practice Address - Street 1:7564 BROWNS MILL RD
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17202-9252
Practice Address - Country:US
Practice Address - Phone:717-375-4834
Practice Address - Fax:717-375-4067
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-14
Last Update Date:2025-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025348103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist