Provider Demographics
NPI:1841643517
Name:BERGMAN, KAYLA (MS, LPC, NCC, CAADC)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:BERGMAN
Suffix:
Gender:F
Credentials:MS, LPC, NCC, CAADC
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:
Other - Last Name:PERKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:523 BANK ST
Mailing Address - Street 2:
Mailing Address - City:SEWICKLEY
Mailing Address - State:PA
Mailing Address - Zip Code:15143-1803
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1017 PERRY HWY STE 5
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-2173
Practice Address - Country:US
Practice Address - Phone:412-915-0336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-19
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
PAPC011208101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator