Provider Demographics
NPI:1255638334
Name:BERGERON, JENNIFER L (PSYD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:BERGERON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 COLLEGE STREET, SUITE 6
Mailing Address - Street 2:JAMES LEVINE & ASSOCIATES, P.C.
Mailing Address - City:SOUTH HADLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01075
Mailing Address - Country:US
Mailing Address - Phone:413-534-7400
Mailing Address - Fax:413-534-7483
Practice Address - Street 1:9 COLLEGE ST
Practice Address - Street 2:SUITE 6
Practice Address - City:SOUTH HADLEY
Practice Address - State:MA
Practice Address - Zip Code:01075-1421
Practice Address - Country:US
Practice Address - Phone:413-534-7400
Practice Address - Fax:413-534-7483
Is Sole Proprietor?:No
Enumeration Date:2011-02-25
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8548103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical