Provider Demographics
NPI:1477500809
Name:BERGMAN, SCOTT (PHD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:BERGMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:387 N RIDGE ST
Mailing Address - Street 2:
Mailing Address - City:RYE BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:10573-1103
Mailing Address - Country:US
Mailing Address - Phone:914-698-0497
Mailing Address - Fax:914-937-8797
Practice Address - Street 1:387 N RIDGE ST
Practice Address - Street 2:
Practice Address - City:RYE BROOK
Practice Address - State:NY
Practice Address - Zip Code:10573-1103
Practice Address - Country:US
Practice Address - Phone:914-698-0497
Practice Address - Fax:914-937-8797
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009100103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV56031Medicare UPIN