Provider Demographics
NPI:1285860361
Name:BERGMAN, MARLA DAREFSKY (MACCCSLP)
Entity Type:Individual
Prefix:MRS
First Name:MARLA
Middle Name:DAREFSKY
Last Name:BERGMAN
Suffix:
Gender:F
Credentials:MACCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:439 PINEBROOK BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10804-3927
Mailing Address - Country:US
Mailing Address - Phone:914-576-0720
Mailing Address - Fax:
Practice Address - Street 1:439 PINEBROOK BLVD
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10804-3927
Practice Address - Country:US
Practice Address - Phone:914-576-0720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist