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General NPI Number Information
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NPI Number | 1255997599
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Entity Type | Organization
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Legal Business Name | JANA BERGFELD LISW LLC
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Dates
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Enumeration Date | 05/13/2019
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Last Update Date | 05/13/2019
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Provider Practice Location Address
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Address Line | 1071 FISHINGER RD STE 211
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City | COLUMBUS
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State | OH
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Zip | 43221-2301
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Country | US
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Telephone | 708-373-5959
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Fax |
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Provider Business Mailing Address
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Address Line | 2693 BERWYN RD
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City | COLUMBUS
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State | OH
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Zip | 43221-3207
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Country | US
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Telephone | 708-373-5959
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/LIC. CLINICAL SOCIAL WORK
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Name | JANA BERGFELD
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Credential | MSW
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Telephone | 708-373-5959
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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