Provider Demographics
NPI:1255778700
Name:BERGERON, ROSIMERY DA SILVA LOPES (LPC, CRC, MS)
Entity type:Individual
Prefix:MR
First Name:ROSIMERY
Middle Name:DA SILVA LOPES
Last Name:BERGERON
Suffix:
Gender:F
Credentials:LPC, CRC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 716
Mailing Address - Street 2:
Mailing Address - City:CAMP SHERMAN
Mailing Address - State:OR
Mailing Address - Zip Code:97730-0716
Mailing Address - Country:US
Mailing Address - Phone:503-917-1239
Mailing Address - Fax:888-506-5070
Practice Address - Street 1:750 NW CHARBONNEAU DR.
Practice Address - Street 2:SUITE 211
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703
Practice Address - Country:US
Practice Address - Phone:503-917-1239
Practice Address - Fax:888-506-5070
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-23
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC3130101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health