Provider Demographics
NPI:1285300814
Name:BERGERSEN, BRITTANY MARGOT
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:MARGOT
Last Name:BERGERSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 DEEPDALE PKWY
Mailing Address - Street 2:
Mailing Address - City:ALBERTSON
Mailing Address - State:NY
Mailing Address - Zip Code:11507-1327
Mailing Address - Country:US
Mailing Address - Phone:516-661-3409
Mailing Address - Fax:
Practice Address - Street 1:59 DEEPDALE PKWY
Practice Address - Street 2:
Practice Address - City:ALBERTSON
Practice Address - State:NY
Practice Address - Zip Code:11507-1327
Practice Address - Country:US
Practice Address - Phone:516-661-3409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health