Healthcare Provider Details

I. General information

NPI: 1245938935
Provider Name (Legal Business Name): HELENA BERGMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LENA BERGMAN

II. Dates (important events)

Enumeration Date: 02/21/2023
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11585 PAINT LICK SPUR
PAINT LICK KY
40461-8370
US

IV. Provider business mailing address

11585 PAINT LICK SPUR
PAINT LICK KY
40461-8370
US

V. Phone/Fax

Practice location:
  • Phone: 859-925-4610
  • Fax:
Mailing address:
  • Phone: 859-925-4610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number259959
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: