Provider Demographics
NPI:1447527601
Name:BERGMANN, SUZANNE MICHELE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:MICHELE
Last Name:BERGMANN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 COMMACK RD # 1027
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-3442
Mailing Address - Country:US
Mailing Address - Phone:631-600-3407
Mailing Address - Fax:
Practice Address - Street 1:169 COMMACK RD # 1027
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-3442
Practice Address - Country:US
Practice Address - Phone:631-600-3407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-16
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC060825001041C0700X
NY072486104100000X
NY0829131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT089.0135391TELEOtherOUT-OF-STATE TELEHEALTH PROVIDER
NJ44SC06082500OtherLCSW LICENSE NUMBER
FLTPSW1585OtherOUT-OF-STATE TELEHEALTH PROVIDER
NY082913OtherLCSW LICENSE NUMBER
SCTLS425CPOtherOUT-OF-STATE TELEHEALTH PROVIDER
DEQ5-0000089OtherOUT-OF-STATE TELEHEALTH PROVIDER
VA0904015217OtherLCSW LICENSE NUMBER
MELC23140OtherLCSW LICENSE NUMBER
WVTH00946707OtherOUT-OF-STATE TELEHEALTH PROVIDER