Provider Demographics
NPI:1861632960
Name:BERGEN PSYCHOTHERAPY & GROUP, P.C.
Entity type:Organization
Organization Name:BERGEN PSYCHOTHERAPY & GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAYN
Authorized Official - Suffix:
Authorized Official - Credentials:PC
Authorized Official - Phone:201-986-9872
Mailing Address - Street 1:542 CLARK RD
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-5606
Mailing Address - Country:US
Mailing Address - Phone:201-986-9872
Mailing Address - Fax:201-986-0397
Practice Address - Street 1:542 CLARK RD
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-5606
Practice Address - Country:US
Practice Address - Phone:201-986-9872
Practice Address - Fax:201-986-0397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC00191800102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalystGroup - Single Specialty