Healthcare Provider Details

I. General information

NPI: 1770162158
Provider Name (Legal Business Name): JULIE BERGLUND MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2021
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1282 ROCKLEDGE BLVD STE 2
ROCKLEDGE FL
32955-2747
US

IV. Provider business mailing address

3643 MIDDLEBURG LN APT 107
ROCKLEDGE FL
32955-4547
US

V. Phone/Fax

Practice location:
  • Phone: 800-614-4124
  • Fax: 888-217-4124
Mailing address:
  • Phone: 800-614-4124
  • Fax: 888-217-4124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: