Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | ||
N | 103T00000X | Psychologist | ||
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | ||
Y | 103G00000X | Clinical Psychologist | 022176 | NY |
Y | 103TC0700X | Clinical Psychologist | 022176 | NY |
NPI | 1548573645 |
---|---|
Provider Name | Dr. Jennifer Lynn Bergmann |
First Address | Norwalk, CT 06854-4013 |
Second Address | San Francisco, CA 94131-1957 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2010 |
Last Update Date | 08/07/2019 |