Provider Demographics
NPI:1285683433
Name:BERGMAN, LYNN ANNE (MS, LICSW)
Entity Type:Individual
Prefix:MS
First Name:LYNN
Middle Name:ANNE
Last Name:BERGMAN
Suffix:
Gender:F
Credentials:MS, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 BLACKBERRY LN
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-2117
Mailing Address - Country:US
Mailing Address - Phone:603-357-2357
Mailing Address - Fax:603-357-2357
Practice Address - Street 1:81 COURT ST
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-3409
Practice Address - Country:US
Practice Address - Phone:603-357-2357
Practice Address - Fax:603-357-2357
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH51041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical