Provider Demographics
NPI:1417248626
Name:BERGGREN, BRAD MATTHEW (LCSW)
Entity Type:Individual
Prefix:
First Name:BRAD
Middle Name:MATTHEW
Last Name:BERGGREN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 LAFAYETTE ST
Mailing Address - Street 2:SUITE 140
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70130-3206
Mailing Address - Country:US
Mailing Address - Phone:504-525-2366
Mailing Address - Fax:504-525-7525
Practice Address - Street 1:400 LAFAYETTE ST
Practice Address - Street 2:SUITE 140
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70130-3206
Practice Address - Country:US
Practice Address - Phone:504-525-2366
Practice Address - Fax:504-525-7525
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-21
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA89801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical