Provider Demographics
NPI:1528935368
Name:BERGMAN, SHOSHANA DACHS (PSYD)
Entity type:Individual
Prefix:DR
First Name:SHOSHANA
Middle Name:DACHS
Last Name:BERGMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:SHOSHANA
Other - Middle Name:
Other - Last Name:DACHS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:354 N WOODLAND ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-2027
Mailing Address - Country:US
Mailing Address - Phone:917-723-1498
Mailing Address - Fax:
Practice Address - Street 1:354 N WOODLAND ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2027
Practice Address - Country:US
Practice Address - Phone:917-723-1498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-17
Last Update Date:2025-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY07019103TC0700X
NJ35S10070600103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical