Provider Demographics
NPI:1932378510
Name:BERGMAN, TRACEY KING
Entity Type:Individual
Prefix:MS
First Name:TRACEY
Middle Name:KING
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 1:86 WESTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06515-2227
Mailing Address - Country:US
Mailing Address - Phone:203-387-4908
Mailing Address - Fax:
Practice Address - Street 1:61 COLONY ST
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06451-3210
Practice Address - Country:US
Practice Address - Phone:203-235-2507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-27
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist