Provider Demographics
NPI:1588947055
Name:BERGERSON, DUSTIN (LCSW)
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:
Last Name:BERGERSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4315 DIPLOMACY DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5926
Mailing Address - Country:US
Mailing Address - Phone:907-729-5259
Mailing Address - Fax:907-729-3349
Practice Address - Street 1:4315 DIPLOMACY DR
Practice Address - Street 2:BURT
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5925
Practice Address - Country:US
Practice Address - Phone:910-495-3496
Practice Address - Fax:907-729-8998
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0074911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical