Provider Demographics
NPI:1124372875
Name:ERGO, MICHAEL GEOFFREY (MSW)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:GEOFFREY
Last Name:ERGO
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 WILLOW PASS RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-7930
Mailing Address - Country:US
Mailing Address - Phone:925-680-4526
Mailing Address - Fax:925-680-0410
Practice Address - Street 1:1333 WILLOW PASS RD
Practice Address - Street 2:SUITE 106
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-7930
Practice Address - Country:US
Practice Address - Phone:925-680-4526
Practice Address - Fax:925-680-0410
Is Sole Proprietor?:No
Enumeration Date:2012-11-02
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker