Provider Demographics
NPI:1538342902
Name:GAY, BRIDGET MICHELLE (BS)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:MICHELLE
Last Name:GAY
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 BEACHVIEW DR NE
Mailing Address - Street 2:
Mailing Address - City:FT WALTON BCH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-2835
Mailing Address - Country:US
Mailing Address - Phone:850-543-5925
Mailing Address - Fax:
Practice Address - Street 1:236 BEACHVIEW DR.
Practice Address - Street 2:
Practice Address - City:FT. WALTON BCH.
Practice Address - State:FL
Practice Address - Zip Code:32547-3218
Practice Address - Country:US
Practice Address - Phone:850-543-5925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-08
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPENDINGMedicaid