Healthcare Provider Details

I. General information

NPI: 1518645357
Provider Name (Legal Business Name): BERNADETTE PIGEON PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2023
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6734 S WILLOW ST
CENTENNIAL CO
80112-6812
US

IV. Provider business mailing address

6734 S WILLOW ST
CENTENNIAL CO
80112-6812
US

V. Phone/Fax

Practice location:
  • Phone: 610-506-8747
  • Fax:
Mailing address:
  • Phone: 610-506-8747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSYC.00014972
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: