Provider Demographics
NPI:1487704193
Name:BERGMAN, MARION LEVY
Entity type:Individual
Prefix:MS
First Name:MARION
Middle Name:LEVY
Last Name:BERGMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8152
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08650-0152
Mailing Address - Country:US
Mailing Address - Phone:610-212-1814
Mailing Address - Fax:
Practice Address - Street 1:89 MARSHALL AVE
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08610
Practice Address - Country:US
Practice Address - Phone:610-212-1814
Practice Address - Fax:609-587-8116
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW010091L104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker