MEDICARE: SUNRISE PSYCHOLOGICAL SERVICES, INC.

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
1	103TC0700X	Clinical Psychologist	5883	OH

General Provider Information

NPI Number	:	1932125648
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNRISE PSYCHOLOGICAL SERVICES, INC.

Provider Business Mailing Address
First Line	:	1703 BIRTLES CT
Second Line	:
City	:	GALENA
State	:	OH
Zip	:	43021-8131
Country	:	US
Telephone Number	:	614-961-2203
Fax Number	:

Provider Business Practice Location Address
First Line	:	1703 BIRTLES CT
Second Line	:
City	:	GALENA
State	:	OH
Zip	:	43021-8131
Country	:	US
Telephone Number	:	614-961-2203
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MELANIE ANNE BERGSTEN
Credential	:	PH.D.
Telephone Number	:	614-961-2203

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	07/14/2025

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