Provider Demographics
NPI:1417517368
Name:BERGMAN, EMMA RACHEL (LCSW)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:RACHEL
Last Name:BERGMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5833 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-3021
Mailing Address - Country:US
Mailing Address - Phone:203-506-5091
Mailing Address - Fax:
Practice Address - Street 1:3600 MARKET ST
Practice Address - Street 2:SCIENCE LEADERSHIP ACADEMY MIDDLE SCHOOL
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-3021
Practice Address - Country:US
Practice Address - Phone:215-400-8320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0205831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical