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General NPI Number Information
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NPI Number | 1669518924
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Entity Type | Individual
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Provider Name | IGOR BEREGNOI PHD, L.P.C
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Gender | Male
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 08/02/2011
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Provider Practice Location Address
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Address Line | 2083 CENTER AVE 3H
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City | FORT LEE
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State | NJ
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Zip | 07024-7400
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Country | US
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Telephone | 201-585-2334
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Fax | 201-585-2807
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Provider Business Mailing Address
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Address Line | 1090 GREEN CHAPEL RD.
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City | CRESCO
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State | PA
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Zip | 18326
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Country | US
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Telephone | 570-730-6399
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PC00194
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 8933
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PS-015152
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License Number State | PA
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Taxonomy #4
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | B1-000542
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License Number State | DE
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