Provider Demographics
NPI:1215446562
Name:BERGUES, JENNIFER N
Entity type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:N
Last Name:BERGUES
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10564 SW 131ST CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-3438
Mailing Address - Country:US
Mailing Address - Phone:786-547-9217
Mailing Address - Fax:
Practice Address - Street 1:10564 SW 131ST CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-3438
Practice Address - Country:US
Practice Address - Phone:786-547-9217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-28
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X, 103K00000X
FL1-23-63737103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst