Provider Demographics
NPI:1508931783
Name:BERGOFSKY, REBECA E I (CLINICAL SOCIAL WORK)
Entity Type:Individual
Prefix:MRS
First Name:REBECA
Middle Name:E
Last Name:BERGOFSKY
Suffix:I
Gender:F
Credentials:CLINICAL SOCIAL WORK
Other - Prefix:MRS
Other - First Name:REBECA
Other - Middle Name:E
Other - Last Name:BERGOFSKY
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:CLINICAL SOCIAL WORK
Mailing Address - Street 1:55 CENTRAL PARK WEST
Mailing Address - Street 2:10D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-6003
Mailing Address - Country:US
Mailing Address - Phone:212-579-1184
Mailing Address - Fax:
Practice Address - Street 1:55 CENTRAL PARK W APT 10D
Practice Address - Street 2:10D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-6003
Practice Address - Country:US
Practice Address - Phone:212-579-1184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR001978101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical