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NPI Code Detail

MEDICARE: MR. JOHN JOSEPH BERGIN JR. LIMHP, LMSW

MEDICARE: MR. JOHN JOSEPH BERGIN JR. LIMHP, LMSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorNE
21041C0700XClinical Social WorkerNE

General Provider Information

NPI Number : 1326587593
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JOHN JOSEPH BERGIN JR. LIMHP, LMSW
Provider Business Mailing Address
First Line : 10846 OLD MILL RD
Second Line : SUITE 5
City : OMAHA
State : NE
Zip : 68154-2652
Country : US
Telephone Number : 402-359-0028
Fax Number :
Provider Business Practice Location Address
First Line : 10846 OLD MILL RD
Second Line : SUITE 5
City : OMAHA
State : NE
Zip : 68154-2652
Country : US
Telephone Number : 402-359-0028
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/21/2017
Last Update Date : 02/21/2017

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