Provider Demographics
NPI:1245938935
Name:BERGMAN, HELENA
Entity type:Individual
Prefix:
First Name:HELENA
Middle Name:
Last Name:BERGMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LENA
Other - Middle Name:
Other - Last Name:BERGMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11585 PAINT LICK SPUR
Mailing Address - Street 2:
Mailing Address - City:PAINT LICK
Mailing Address - State:KY
Mailing Address - Zip Code:40461-8370
Mailing Address - Country:US
Mailing Address - Phone:859-925-4610
Mailing Address - Fax:
Practice Address - Street 1:11585 PAINT LICK SPUR
Practice Address - Street 2:
Practice Address - City:PAINT LICK
Practice Address - State:KY
Practice Address - Zip Code:40461-8370
Practice Address - Country:US
Practice Address - Phone:859-925-4610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-21
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2599591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical