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Individual

MRS. CODY COOPER BERGERON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LCSW

Contact information

Practice address
425 KINGS HWY E, FAIRFIELD, CT 06825-4852
(203) 307-0119
Mailing address
516 WOODRIDGE AVE, FAIRFIELD, CT 06825-2577
(203) 247-9039

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
8934
CT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
8934
LICENSED CLINICAL SOCIAL WORKER
CT
Enumeration date
09/17/2013
Last updated
12/06/2021
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