Provider Demographics
NPI:1154753192
Name:BERGMAN, RIFKIE RITA (LCSW)
Entity type:Individual
Prefix:
First Name:RIFKIE
Middle Name:RITA
Last Name:BERGMAN
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 1:1669 E 23RD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1518
Mailing Address - Country:US
Mailing Address - Phone:718-787-4412
Mailing Address - Fax:718-787-4418
Practice Address - Street 1:813 QUENTIN RD
Practice Address - Street 2:COUNTERFORCE SUITE 203
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-2251
Practice Address - Country:US
Practice Address - Phone:718-787-4412
Practice Address - Fax:718-787-4418
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-01
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR053971-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical