| Doctor Name: | MARILYN BERGMAN |
| NPI Number: | 1013969682 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PH.D |
| License Number: | PS002674L |
| Business Practice Address: | 308 E Lancaster Ave Suite 200 Wynnewood, PA - 190962145 |
| Business Phone Number: | 6106422353 |
| Business Fax Number: | 6106423278 |
| Mailing Address: | 308 E Lancaster Ave, Suite 200 WYNNEWOOD |
| State: | PA |
| Postal Code: | 190962145 |
| Phone Number: | 6106422353 |
| Fax Number: | 6106423278 |
| NPI Enumeration Date: | 05/16/2006 |
| NPI Last Update Date: | 06/11/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | PS002674L |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |