Healthcare Provider Details

I. General information

NPI: 1356613186
Provider Name (Legal Business Name): DR. BERGIN PSYCHOTHERAPY FAMILY SERVICE,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2012
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6800 INDIANA AVE STE 130
RIVERSIDE CA
92506-4266
US

IV. Provider business mailing address

17130 VAN BUREN BLVD # 341
RIVERSIDE CA
92504-5905
US

V. Phone/Fax

Practice location:
  • Phone: 951-684-6684
  • Fax:
Mailing address:
  • Phone: 951-684-6684
  • Fax: 951-684-7503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number40818
License Number StateCA

VIII. Authorized Official

Name: DR. AINE M BERGIN
Title or Position: OWNER
Credential: PSY.D
Phone: 951-684-6684