Provider Demographics
NPI:1255629051
Name:BERGERON, SHARLENE (BCBA)
Entity type:Individual
Prefix:MRS
First Name:SHARLENE
Middle Name:
Last Name:BERGERON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4809 N HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-2001
Mailing Address - Country:US
Mailing Address - Phone:412-605-9865
Mailing Address - Fax:
Practice Address - Street 1:4809 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-2001
Practice Address - Country:US
Practice Address - Phone:412-605-9865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-13
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst