Provider Demographics
NPI:1144043605
Name:BERGERON, CARTER GERARD
Entity type:Individual
Prefix:MR
First Name:CARTER
Middle Name:GERARD
Last Name:BERGERON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 W 44TH ST APT 2E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-4438
Mailing Address - Country:US
Mailing Address - Phone:203-979-8815
Mailing Address - Fax:
Practice Address - Street 1:407 W 44TH ST APT 2E
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-4438
Practice Address - Country:US
Practice Address - Phone:203-979-8815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health