Provider Demographics
NPI:1699749671
Name:BERGEN, JANET J (MSW)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:J
Last Name:BERGEN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 PLAINFIELD AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-2598
Mailing Address - Country:US
Mailing Address - Phone:732-777-1940
Mailing Address - Fax:732-777-1889
Practice Address - Street 1:515 PLAINFIELD AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-2598
Practice Address - Country:US
Practice Address - Phone:732-777-1940
Practice Address - Fax:732-777-1889
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC001595001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ70036AHUMedicare ID - Type Unspecified