Doctor Name: | MR. ROSIMERY DA SILVA LOPES BERGERON |
NPI Number: | 1255778700 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC, CRC, MS |
License Number: | C3130 |
Business Practice Address: | 177 Whitman St S Monmouth, OR - 973612034 |
Business Phone Number: | 5039171239 |
Business Fax Number: | |
Mailing Address: | 177 Whitman St S, MONMOUTH |
State: | OR |
Postal Code: | 973612034 |
Phone Number: | 5039171239 |
Fax Number: | |
NPI Enumeration Date: | 05/23/2013 |
NPI Last Update Date: | 05/23/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | C3130 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OR |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |