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NPI Code Detail

MEDICARE: MS. ROBYN BETH BERGER-GASTON LCSW

MEDICARE: MS. ROBYN BETH BERGER-GASTON LCSW
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
11041C0700XClinical Social Worker69769NY

General Provider Information

NPI Number : 1376745778
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ROBYN BETH BERGER-GASTON LCSW
Provider Business Mailing Address
First Line : 25 HURON ST
Second Line :
City : PORT JEFFERSON STATION
State : NY
Zip : 11776-4312
Country : US
Telephone Number : 631-828-1121
Fax Number : 631-828-1121
Provider Business Practice Location Address
First Line : 208 ROANOKE AVE
Second Line :
City : RIVERHEAD
State : NY
Zip : 11901-2706
Country : US
Telephone Number : 631-369-0104
Fax Number : 631-369-5433
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2007
Last Update Date : 07/08/2007

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