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General NPI Number Information
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NPI Number | 1245701580
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Entity Type | Organization
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Legal Business Name | BRANDON BERGMAN, PHD, LLC
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Dates
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Enumeration Date | 12/16/2018
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Last Update Date | 12/16/2018
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Provider Practice Location Address
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Address Line | 1180 BEACON ST STE 4B
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City | BROOKLINE
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State | MA
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Zip | 02446-3806
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Country | US
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Telephone | 978-558-0644
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Fax |
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Provider Business Mailing Address
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Address Line | 1530 BEACON ST APT 902
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City | BROOKLINE
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State | MA
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Zip | 02446-2645
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | DR. BRANDON BERGMAN
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Credential | PHD
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Telephone | 978-558-0644
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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