Provider Demographics
NPI:1093889461
Name:BERGEN, ARLEEN (CSW)
Entity Type:Individual
Prefix:MS
First Name:ARLEEN
Middle Name:
Last Name:BERGEN
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 E 84TH ST
Mailing Address - Street 2:#2K
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-2008
Mailing Address - Country:US
Mailing Address - Phone:212-879-2974
Mailing Address - Fax:212-879-2974
Practice Address - Street 1:160 E 84TH ST
Practice Address - Street 2:#2K
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-2008
Practice Address - Country:US
Practice Address - Phone:212-879-2974
Practice Address - Fax:212-879-2974
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR025837-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02025092Medicaid
NYN45271Medicare ID - Type UnspecifiedSOCIAL WORK