Provider Demographics
NPI:1053629360
Name:BERGMAN, DANA MARK (MED)
Entity Type:Individual
Prefix:MR
First Name:DANA
Middle Name:MARK
Last Name:BERGMAN
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:44 FRONT ST
Mailing Address - Street 2:SUITE 490
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1733
Mailing Address - Country:US
Mailing Address - Phone:508-753-0321
Mailing Address - Fax:508-770-1732
Practice Address - Street 1:44 FRONT ST
Practice Address - Street 2:SUITE 490
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1733
Practice Address - Country:US
Practice Address - Phone:508-753-0321
Practice Address - Fax:508-770-1732
Is Sole Proprietor?:No
Enumeration Date:2010-09-21
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
101YA0400X
MA1649344821101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)