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NPI Code Detail

MEDICARE: KAREN BERGERON

MEDICARE: KAREN BERGERON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1386212496
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAREN BERGERON
Provider Business Mailing Address
First Line : 132 W COURT ST APT 1
Second Line :
City : WOODSTOCK
State : VA
Zip : 22664-1409
Country : US
Telephone Number : 571-481-6013
Fax Number :
Provider Business Practice Location Address
First Line : 130 CARRIEBROOKE DR
Second Line :
City : STEPHENS CITY
State : VA
Zip : 22655-6000
Country : US
Telephone Number : 540-486-4653
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2021
Last Update Date : 06/15/2021

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