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Bridgette K Hathaway

Social Worker

Behavioral Health & Social Service Providers

109 W 27th St Ste 5s, New York, NY 10001-0265

PECOS Enrollment

This provider is enrolled in PECOS as BRIDGETTE HATHAWAY.

Based on the most recent information from CMS, provider Bridgette K Hathaway is legally eligible to order and refer claims for Part B and DME services only.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records yesterday at 2:56 PM.

Profile Details

Provider ID
1275141061
Provider Type
Individual
Full Name
Hathaway, Bridgette K
Credential
LCSW

Gender
Female
Sole Proprietor
Yes
Enumeration Date
7/17/2020
Last Updated
10/29/2024

Contact Information

Practice Location

109 W 27th St Ste 5s, New York, NY 10001-0265

(833) 351-8255

Unlisted Fax

Mailing Location

PO Box 24449, New York, NY 10087-0589

(833) 351-8255

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 1041C0700X Primary	Description Social Worker Behavioral Health & Social Service Providers	License 093976 New York
Code 104100000X	Description Social Worker Behavioral Health & Social Service Providers	License Unlisted Issuer New York
Code 1041C0700X	Description Social Worker Behavioral Health & Social Service Providers	License TPSW3393 Florida

Provider Identifiers

ID	Description	Issuer
ID 02997780	Description Medicaid	Issuer Unlisted New York

Bridgette K Hathaway

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

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Description

License

Code

Description

License

Code

Description

License

Code

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License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Bautista, Dalia

Zylberman, Shani Dalia

Perez, Josephine

Pertz, Eliza Victoria

Marrone, Kathryn

Dastur, Shana

Shecter, Adam James

Tanner, Travis

Wender, Randi

Kappy, Robin