Provider Demographics
NPI:1265685291
Name:BERGERON, MARI-ANNA YUKO (MSSW)
Entity Type:Individual
Prefix:MS
First Name:MARI-ANNA
Middle Name:YUKO
Last Name:BERGERON
Suffix:
Gender:F
Credentials:MSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4650 W SUNSET BLVD
Mailing Address - Street 2:MS#115
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-6062
Mailing Address - Country:US
Mailing Address - Phone:323-361-3932
Mailing Address - Fax:
Practice Address - Street 1:5000 WILSHIRE BLVD
Practice Address - Street 2:520 #J
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-4315
Practice Address - Country:US
Practice Address - Phone:323-361-3932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical