Healthcare Provider Details

I. General information

NPI: 1255997599
Provider Name (Legal Business Name): JANA BERGFELD LISW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2019
Last Update Date: 05/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1071 FISHINGER RD STE 211
COLUMBUS OH
43221-2301
US

IV. Provider business mailing address

2693 BERWYN RD
COLUMBUS OH
43221-3207
US

V. Phone/Fax

Practice location:
  • Phone: 708-373-5959
  • Fax:
Mailing address:
  • Phone: 708-373-5959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JANA BERGFELD
Title or Position: PRESIDENT/LIC. CLINICAL SOCIAL WORK
Credential: MSW
Phone: 708-373-5959