Provider Demographics
NPI:1750331724
Name:BERGANDI, THOMAS ANTON (PHD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ANTON
Last Name:BERGANDI
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 1:851 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40203-2115
Mailing Address - Country:US
Mailing Address - Phone:502-585-9911
Mailing Address - Fax:502-585-7159
Practice Address - Street 1:851 S 4TH ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40203-2115
Practice Address - Country:US
Practice Address - Phone:502-585-9911
Practice Address - Fax:502-585-7159
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY00572103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical