Provider Demographics
NPI:1093020091
Name:BERGERON, SUZANNE ELIZABETH (RNCS)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:ELIZABETH
Last Name:BERGERON
Suffix:
Gender:F
Credentials:RNCS
Other - Prefix:MS
Other - First Name:SUZANNE
Other - Middle Name:ELIZABETH
Other - Last Name:BERGERON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RNCS
Mailing Address - Street 1:2 ADMINISTRATION RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02324-3230
Mailing Address - Country:US
Mailing Address - Phone:508-279-3614
Mailing Address - Fax:508-279-3611
Practice Address - Street 1:2 ADMINISTRATION RD
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02324-3230
Practice Address - Country:US
Practice Address - Phone:508-279-3614
Practice Address - Fax:508-279-3611
Is Sole Proprietor?:No
Enumeration Date:2010-08-13
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN115664364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult