Provider Demographics
NPI:1982234001
Name:BERGERON, MONICA (CFCP)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:BERGERON
Suffix:
Gender:F
Credentials:CFCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 WINSLOW ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:RI
Mailing Address - Zip Code:02915-1725
Mailing Address - Country:US
Mailing Address - Phone:401-871-3410
Mailing Address - Fax:
Practice Address - Street 1:75 WINSLOW ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:RI
Practice Address - Zip Code:02915-1725
Practice Address - Country:US
Practice Address - Phone:401-871-3410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-16
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator