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General NPI Number Information
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NPI Number | 1982238580
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Entity Type | Individual
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Provider Name | CHRISTINE R BERGERON LCSW
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Gender | Female
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Dates
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Enumeration Date | 02/24/2020
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Last Update Date | 01/30/2024
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Provider Practice Location Address
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Address Line | 53 BAXTER BLVD STE 3
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City | PORTLAND
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State | ME
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Zip | 04101-1827
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Country | US
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Telephone | 603-689-6562
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 568
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City | KENNEBUNKPORT
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State | ME
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Zip | 04046-0568
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Country | US
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Telephone | 603-689-6562
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LC23162
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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