Provider Demographics
NPI:1427220516
Name:BERGERON, MARY KATHRYN (LCSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KATHRYN
Last Name:BERGERON
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 1:3400 KNIGHTON RD
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-9498
Mailing Address - Country:US
Mailing Address - Phone:530-224-3822
Mailing Address - Fax:
Practice Address - Street 1:3400 KNIGHTON RD
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-9498
Practice Address - Country:US
Practice Address - Phone:530-224-3822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-28
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA142221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical