Healthcare Provider Details

I. General information

NPI: 1003723511
Provider Name (Legal Business Name): CASSIDY BERGH LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 MAPLEDALE ST
FERNDALE MI
48220
US

IV. Provider business mailing address

712 N DORCHESTER AVE
ROYAL OAK MI
48067-2165
US

V. Phone/Fax

Practice location:
  • Phone: 248-658-5400
  • Fax:
Mailing address:
  • Phone: 513-259-4569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number6851115524
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: