Provider Demographics
NPI:1891221941
Name:BERGEN PSYCHOTHERAPY & NEUROPSYCHOLOGY, INC.
Entity Type:Organization
Organization Name:BERGEN PSYCHOTHERAPY & NEUROPSYCHOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LANA
Authorized Official - Middle Name:ALYCE
Authorized Official - Last Name:TIERSKY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:201-574-7205
Mailing Address - Street 1:17 S FRANKLIN TPKE STE 2
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07446-2536
Mailing Address - Country:US
Mailing Address - Phone:201-574-7205
Mailing Address - Fax:
Practice Address - Street 1:17 S FRANKLIN TPKE STE 2
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446-2536
Practice Address - Country:US
Practice Address - Phone:201-574-7205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty