Provider Demographics
NPI:1720970387
Name:BERGANZA, MARIA FERNANDA BERGANZA (LLP)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:FERNANDA BERGANZA
Last Name:BERGANZA
Suffix:
Gender:F
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 COLUMBIA DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH LYON
Mailing Address - State:MI
Mailing Address - Zip Code:48178-1886
Mailing Address - Country:US
Mailing Address - Phone:248-916-2625
Mailing Address - Fax:
Practice Address - Street 1:3135 S STATE ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-1653
Practice Address - Country:US
Practice Address - Phone:734-369-3180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-17
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6361007931103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty