Provider Demographics
NPI:1184864357
Name:BERGMAN, ANDREA JILL (PHD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:JILL
Last Name:BERGMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 UTOPIA PKWY
Mailing Address - Street 2:SAINT JOHN'S UNIVERSITY
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11439
Mailing Address - Country:US
Mailing Address - Phone:718-990-1550
Mailing Address - Fax:
Practice Address - Street 1:15211 UNION TPKE.
Practice Address - Street 2:CENTER FOR PSYCHOLOGICAL SERVICES
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367
Practice Address - Country:US
Practice Address - Phone:718-990-1550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010356-1103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral