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NPI Code Detail

MEDICARE: MAVE OPAL BERGERON MED, BCBA

MEDICARE: MAVE OPAL BERGERON MED, BCBA
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
1103K00000XBehavior AnalystL747LA

General Provider Information

NPI Number : 1619657806
Entity Type Code : Individual
Provider Name (Legal Business Name) : MAVE OPAL BERGERON MED, BCBA
Provider Business Mailing Address
First Line : 328 S 2ND ST
Second Line :
City : IOTA
State : LA
Zip : 70543-6051
Country : US
Telephone Number : 337-305-6930
Fax Number :
Provider Business Practice Location Address
First Line : 139 JAMES COMEAUX RD STE B
Second Line :
City : LAFAYETTE
State : LA
Zip : 70508-3376
Country : US
Telephone Number : 855-832-6727
Fax Number : 772-675-9100
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/21/2023
Last Update Date : 04/01/2026

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Directions to “ MAVE OPAL BERGERON MED, BCBA” Practice Location

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