Provider Demographics
NPI:1992967525
Name:BERGMAN, JANICE M (LCSW)
Entity type:Individual
Prefix:MS
First Name:JANICE
Middle Name:M
Last Name:BERGMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15100 BOONES FERRY RD
Mailing Address - Street 2:SUITE 700A
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-3469
Mailing Address - Country:US
Mailing Address - Phone:503-636-2877
Mailing Address - Fax:503-635-9127
Practice Address - Street 1:15100 BOONES FERRY RD
Practice Address - Street 2:SUITE 700A
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-3469
Practice Address - Country:US
Practice Address - Phone:503-636-2877
Practice Address - Fax:503-635-9127
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLCSW11561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1156OtherLCSW