Provider Demographics
NPI:1083040232
Name:BERGEN PSYCHOLOGICAL SERVICES, LLC
Entity Type:Organization
Organization Name:BERGEN PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YESENIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:973-432-7230
Mailing Address - Street 1:1605 JOHN ST STE 205B
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-2581
Mailing Address - Country:US
Mailing Address - Phone:973-432-7230
Mailing Address - Fax:201-794-4499
Practice Address - Street 1:1605 JOHN ST STE 208
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-2550
Practice Address - Country:US
Practice Address - Phone:973-432-7230
Practice Address - Fax:201-794-4499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-19
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00492800103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ12345Medicare UPIN