Healthcare Provider Details

I. General information

NPI: 1609808377
Provider Name (Legal Business Name): ANITA JEAN BERGIN MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 STATE ROUTE 35 SUITE 5
KEYPORT NJ
07735-1406
US

IV. Provider business mailing address

117 STATE ROUTE 35 SUITE 5
KEYPORT NJ
07735-1406
US

V. Phone/Fax

Practice location:
  • Phone: 732-264-7999
  • Fax: 732-264-8140
Mailing address:
  • Phone: 732-264-7999
  • Fax: 732-264-8140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSC 000215
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: