Provider Demographics
NPI:1760956023
Name:BERGERON, VERA (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:VERA
Middle Name:
Last Name:BERGERON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MS
Other - First Name:VERA
Other - Middle Name:
Other - Last Name:STANLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:65 HOLBROOK ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:MA
Mailing Address - Zip Code:02056-1848
Mailing Address - Country:US
Mailing Address - Phone:617-765-0900
Mailing Address - Fax:
Practice Address - Street 1:65 HOLBROOK ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:MA
Practice Address - Zip Code:02056-1848
Practice Address - Country:US
Practice Address - Phone:617-765-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-18
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8479101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health