Provider Demographics
NPI:1326468232
Name:BERGMAN, GREG F (LBSW)
Entity Type:Individual
Prefix:MR
First Name:GREG
Middle Name:F
Last Name:BERGMAN
Suffix:
Gender:M
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 W STEVENS ST
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-4240
Mailing Address - Country:US
Mailing Address - Phone:575-885-4191
Mailing Address - Fax:575-885-4194
Practice Address - Street 1:1306 W STEVENS ST
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-4240
Practice Address - Country:US
Practice Address - Phone:575-885-4191
Practice Address - Fax:575-885-4194
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-17
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMB-04595104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker