Provider Demographics
NPI:1225187917
Name:BERGAMIN, MARIA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:
Last Name:BERGAMIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3069 GOMER ST
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:10598-2723
Mailing Address - Country:US
Mailing Address - Phone:914-734-1359
Mailing Address - Fax:
Practice Address - Street 1:612 DEPEW STREET
Practice Address - Street 2:WOODSIDE SCHOOL
Practice Address - City:PEEKSKILL
Practice Address - State:NY
Practice Address - Zip Code:10566
Practice Address - Country:US
Practice Address - Phone:914-734-1359
Practice Address - Fax:914-734-1638
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043515104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY372719OtherHEALTHNET