MEDICARE: HERMINE COHEN-BERGEN LCSW

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
1	101YM0800X	Mental Health Counselor	989743	CO

General Provider Information

NPI Number	:	1710274733
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HERMINE COHEN-BERGEN LCSW

Provider Business Mailing Address
First Line	:	906 MILO CIR APT B
Second Line	:
City	:	LAFAYETTE
State	:	CO
Zip	:	80026-3037
Country	:	US
Telephone Number	:	303-666-1969
Fax Number	:

Provider Business Practice Location Address
First Line	:	16154 ROCK CRYSTAL DR
Second Line	:
City	:	PARKER
State	:	CO
Zip	:	80134-3305
Country	:	US
Telephone Number	:	720-940-8531
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2011
Last Update Date	:	06/29/2011

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