Doctor Name: | MILES T BERGMAN |
NPI Number: | 1578743969 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LCSW |
License Number: | 44SC00528700 |
Business Practice Address: | 1509 4th Ave Asbury Park, NJ - 077124945 |
Business Phone Number: | 7328699477 |
Business Fax Number: | |
Mailing Address: | 1509 4th Ave, ASBURY PARK |
State: | NJ |
Postal Code: | 077124945 |
Phone Number: | 7328699477 |
Fax Number: | |
NPI Enumeration Date: | 11/14/2007 |
NPI Last Update Date: | 11/14/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 44SC00528700 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |