Provider Demographics
NPI:1235118191
Name:BERGMAN, ANNA (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:
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 1:7400 NEW LAGRANGE RD
Mailing Address - Street 2:STE 312
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-4870
Mailing Address - Country:US
Mailing Address - Phone:502-394-9990
Mailing Address - Fax:502-394-9992
Practice Address - Street 1:7400 NEW LAGRANGE RD
Practice Address - Street 2:STE 312
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-4870
Practice Address - Country:US
Practice Address - Phone:502-394-9990
Practice Address - Fax:502-394-9992
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-0428103TC0700X
IN20040387A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY4320227OtherAETNA
KY128686OtherAPS
KY87517OtherCIGNA
KY009406OtherVALUE OPTIONS
KY037912000OtherMAGELLAN
KY179629OtherCOMPSYCH
KY6176262OtherUNITED BEHAVIORAL HEALTH
KY000000047448OtherANTHEM
KY239613OtherMHN
KYR35821Medicare UPIN
KY000000047448OtherANTHEM
KY009406OtherVALUE OPTIONS