Provider Demographics
NPI:1710220157
Name:BERGMAN, FELICIA MARIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:FELICIA
Middle Name:MARIE
Last Name:BERGMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:FELICIA
Other - Middle Name:MARIE
Other - Last Name:ACTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5851 PEARL RD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:PARMA HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-2113
Mailing Address - Country:US
Mailing Address - Phone:440-845-9011
Mailing Address - Fax:440-845-9013
Practice Address - Street 1:5851 PEARL RD
Practice Address - Street 2:#305
Practice Address - City:PARMA HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-2113
Practice Address - Country:US
Practice Address - Phone:440-845-9011
Practice Address - Fax:440-845-9013
Is Sole Proprietor?:No
Enumeration Date:2013-04-04
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7008103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000812656OtherANTHEM
OH0084889Medicaid
H186570OtherMEDICARE PTAN