Healthcare Provider Details

I. General information

NPI: 1992635148
Provider Name (Legal Business Name): RENNIE BERGMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 FOULK RD
WILMINGTON DE
19803-3809
US

IV. Provider business mailing address

405 FOULK RD
WILMINGTON DE
19803-3809
US

V. Phone/Fax

Practice location:
  • Phone: 302-655-3953
  • Fax:
Mailing address:
  • Phone: 302-655-3953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberQ3-0011492
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: