Provider Demographics
NPI:1306218359
Name:BERGMANN, JACQUELINE JOANNE (LMFT)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:JOANNE
Last Name:BERGMANN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1196 BOULEVARD WAY
Mailing Address - Street 2:SUITE 11
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94595-1193
Mailing Address - Country:US
Mailing Address - Phone:925-285-3735
Mailing Address - Fax:
Practice Address - Street 1:1196 BOULEVARD WAY
Practice Address - Street 2:SUITE 11
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94595-1193
Practice Address - Country:US
Practice Address - Phone:925-285-3735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT53013106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist