Provider Demographics
NPI:1417609033
Name:BRIDGEMAN, CASEY LYNNE (N/A)
Entity type:Individual
Prefix:MS
First Name:CASEY
Middle Name:LYNNE
Last Name:BRIDGEMAN
Suffix:
Gender:F
Credentials:N/A
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:LYNNE
Other - Last Name:SHEEHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:135 PINELAWN RD
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-3198
Mailing Address - Country:US
Mailing Address - Phone:774-277-2680
Mailing Address - Fax:
Practice Address - Street 1:14 FORDHAM RD
Practice Address - Street 2:
Practice Address - City:ALLSTON
Practice Address - State:MA
Practice Address - Zip Code:02134-3000
Practice Address - Country:US
Practice Address - Phone:617-782-6460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-25
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10001000101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health