Provider Demographics
NPI:1831639939
Name:BERGMAN, AMBER MICHELLE (LMHC)
Entity type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:MICHELLE
Last Name:BERGMAN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:MICHELLE
Other - Last Name:SHORES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22 DAFFODIL DRIVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12803
Mailing Address - Country:US
Mailing Address - Phone:518-812-4792
Mailing Address - Fax:
Practice Address - Street 1:10 LA CROSSE STREET
Practice Address - Street 2:SUITE 3
Practice Address - City:HUDSON FALLS
Practice Address - State:NY
Practice Address - Zip Code:12839
Practice Address - Country:US
Practice Address - Phone:518-812-4792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-08
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP98952101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health