Provider Demographics
NPI:1821220567
Name:BERGERON, KATHRYN H (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:H
Last Name:BERGERON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MISS
Other - First Name:KATHRYN
Other - Middle Name:H
Other - Last Name:STEVENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:40 CHURCH ST FL 1
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-6115
Mailing Address - Country:US
Mailing Address - Phone:978-674-6744
Mailing Address - Fax:
Practice Address - Street 1:40 CHURCH ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-6113
Practice Address - Country:US
Practice Address - Phone:978-674-6700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-13
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
MALICSW1173641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical