Provider Demographics
NPI:1740528660
Name:BERGERON, DEBRA S (PSYD, LMHC, LCMHC)
Entity type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:S
Last Name:BERGERON
Suffix:
Gender:F
Credentials:PSYD, LMHC, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 DIXON AVE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-4944
Mailing Address - Country:US
Mailing Address - Phone:603-856-8163
Mailing Address - Fax:603-856-8164
Practice Address - Street 1:6 DIXON AVE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-4944
Practice Address - Country:US
Practice Address - Phone:603-856-8163
Practice Address - Fax:603-856-8164
Is Sole Proprietor?:No
Enumeration Date:2013-01-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH521101YM0800X
MA4606101YM0800X
NH1154103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health