Individual
MR. THOMAS ANTON BERGVIK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA, LPC
Contact information
Practice address
3074 WHITNEY AVE, BUILDING I 2ND FLOOR, HAMDEN, CT 06518-2391
(860) 305-2764
(203) 287-2404
Mailing address
3074 WHITNEY AVE, BUILDING I 2ND FLOOR, HAMDEN, CT 06518-2391
(860) 305-2764
(203) 287-2404
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2440
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008049135
—
CT
Enumeration date
01/05/2010
Last updated
02/03/2014
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