Healthcare Provider Details

I. General information

NPI: 1124242045
Provider Name (Legal Business Name): BARBARA JANE BERGMANN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BARBARA JANE KALISH PH.D

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 S FEDERAL HWY
FORT LAUDERDALE FL
33316-2619
US

IV. Provider business mailing address

1401 S FEDERAL HWY
FORT LAUDERDALE FL
33316-2619
US

V. Phone/Fax

Practice location:
  • Phone: 954-728-1117
  • Fax: 954-779-2316
Mailing address:
  • Phone: 954-728-8080
  • Fax: 954-779-2316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License NumberSS520
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY4399
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License NumberPY4399
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: