Provider Demographics
NPI:1841355377
Name:BERGHERR, THERESA ANN (MD)
Entity type:Individual
Prefix:DR
First Name:THERESA
Middle Name:ANN
Last Name:BERGHERR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:357 WHITNEY AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-2364
Mailing Address - Country:US
Mailing Address - Phone:203-562-6400
Mailing Address - Fax:203-562-6401
Practice Address - Street 1:357 WHITNEY AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-2364
Practice Address - Country:US
Practice Address - Phone:203-562-6400
Practice Address - Fax:203-562-6401
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0330862084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT202383OtherMHN ID NUMBER
CT010033086CT04OtherANTHEM BCBS