Provider Demographics
NPI:1043821580
Name:BERGSTROM, DESIREE PATRICIA
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:PATRICIA
Last Name:BERGSTROM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 HERON RD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:NH
Mailing Address - Zip Code:03819-3038
Mailing Address - Country:US
Mailing Address - Phone:857-928-3890
Mailing Address - Fax:
Practice Address - Street 1:7 HERON RD
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:NH
Practice Address - Zip Code:03819-3038
Practice Address - Country:US
Practice Address - Phone:857-928-3890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker