Provider Demographics
NPI:1821172826
Name:BERGMAN, JANICE BLAKE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:BLAKE
Last Name:BERGMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:JANICE
Other - Middle Name:BLAKE
Other - Last Name:DUFFY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:20 ROSLYN LN
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-3616
Mailing Address - Country:US
Mailing Address - Phone:845-638-4926
Mailing Address - Fax:
Practice Address - Street 1:55 OLD TURNPIKE RD
Practice Address - Street 2:SUITE 601
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-2461
Practice Address - Country:US
Practice Address - Phone:845-627-3413
Practice Address - Fax:212-567-9476
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007741103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02206444Medicaid
NYV65662OtherEMPIRE BCBS
NY61-32223OtherUNITED BEHAVIORAL HEALTH
NY5065663OtherAETNA
NY6802403OtherVALUEOPTIONS/GHI
NY142513000OtherMAGELLAN