Provider Demographics
NPI:1285666800
Name:BERGFJORD, ELIZABETH HARRIETT (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:HARRIETT
Last Name:BERGFJORD
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 1:78 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820-2409
Mailing Address - Country:US
Mailing Address - Phone:607-433-0161
Mailing Address - Fax:
Practice Address - Street 1:78 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-2409
Practice Address - Country:US
Practice Address - Phone:607-433-0161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071 251 1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health