Provider Demographics
NPI:1659331973
Name:BERGERON, CLAIRE E (MS, LADC, CCS)
Entity Type:Individual
Prefix:
First Name:CLAIRE
Middle Name:E
Last Name:BERGERON
Suffix:
Gender:F
Credentials:MS, LADC, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 LISBON ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-5721
Mailing Address - Country:US
Mailing Address - Phone:207-753-0213
Mailing Address - Fax:
Practice Address - Street 1:1008 LISBON ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-5721
Practice Address - Country:US
Practice Address - Phone:207-753-0213
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC1298101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)