Provider Demographics
NPI:1609808377
Name:BERGIN, ANITA JEAN (MSW)
Entity Type:Individual
Prefix:MS
First Name:ANITA
Middle Name:JEAN
Last Name:BERGIN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 STATE ROUTE 35
Mailing Address - Street 2:SUITE 5
Mailing Address - City:KEYPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:07735-1406
Mailing Address - Country:US
Mailing Address - Phone:732-264-7999
Mailing Address - Fax:732-264-8140
Practice Address - Street 1:117 STATE ROUTE 35
Practice Address - Street 2:SUITE 5
Practice Address - City:KEYPORT
Practice Address - State:NJ
Practice Address - Zip Code:07735-1406
Practice Address - Country:US
Practice Address - Phone:732-264-7999
Practice Address - Fax:732-264-8140
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSC 0002151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP2942323OtherOXFORD
NJ29202OtherCIGNA
NJ0467769000OtherAMERIHEALTH
NJ0080073OtherGHI
NJ169348OtherMHN/HEALTHNET
NJ270606OtherVALUE OPTIONS
NJ34930600OtherMAGELLAN BEHAVIORAL HEALT
NJ637535Medicare ID - Type UnspecifiedPROVIDER #
NJS15049Medicare PIN