Provider Demographics
NPI:1326587593
Name:BERGIN, JOHN JOSEPH JR (LIMHP, LMSW)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:JOSEPH
Last Name:BERGIN
Suffix:JR
Gender:M
Credentials:LIMHP, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10846 OLD MILL RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-2652
Mailing Address - Country:US
Mailing Address - Phone:402-359-0028
Mailing Address - Fax:
Practice Address - Street 1:10846 OLD MILL RD
Practice Address - Street 2:SUITE 5
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-2652
Practice Address - Country:US
Practice Address - Phone:402-359-0028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-21
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health