Provider Demographics
NPI:1750530291
Name:BERGMAN, MARJORIE H
Entity type:Individual
Prefix:MRS
First Name:MARJORIE
Middle Name:H
Last Name:BERGMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8655 E. VIA DE VENTURA
Mailing Address - Street 2:G-233
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258
Mailing Address - Country:US
Mailing Address - Phone:480-991-8904
Mailing Address - Fax:480-346-1010
Practice Address - Street 1:8655 E. VIA DE VENTURA
Practice Address - Street 2:G-233
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258
Practice Address - Country:US
Practice Address - Phone:480-991-8904
Practice Address - Fax:480-346-1010
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-0876101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0876OtherL.P.C.
29746OtherN.C.C.