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General NPI Number Information
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NPI Number | 1023332764
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Entity Type | Organization
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Legal Business Name | RONALD L. BERGMAN, PH.D., P.A.
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Dates
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Enumeration Date | 03/24/2010
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Last Update Date | 03/24/2010
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Provider Practice Location Address
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Address Line | 2627 NE 203RD ST S-214
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City | MIAMI
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State | FL
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Zip | 33180-1900
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Country | US
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Telephone | 305-932-3666
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Fax |
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Provider Business Mailing Address
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Address Line | 2627 NE 203RD ST S-214
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City | MIAMI
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State | FL
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Zip | 33180-1900
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Country | US
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Telephone | 305-932-3666
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RONALD L BERGMAN
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Credential | PH.D.
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Telephone | 305-932-3666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY2048
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License Number State | FL
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