Healthcare Provider Details

I. General information

NPI: 1679496749
Provider Name (Legal Business Name): RENEE BERGIN LPC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 ROUTE 66 STE 150
TINTON FALLS NJ
07753-2645
US

IV. Provider business mailing address

1907 GREVE AVE APT I
SPRING LAKE NJ
07762-2356
US

V. Phone/Fax

Practice location:
  • Phone: 732-779-7307
  • Fax:
Mailing address:
  • Phone: 732-779-7307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: RENEE BERGIN
Title or Position: OWNER
Credential: LPC
Phone: 732-779-7307