Individual
THERESA BERGEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
495 HOFFMAN LN, HAUPPAUGE, NY 11788-3102
(631) 863-3000
Mailing address
20 PAUCHOGUE AVE, EAST ISLIP, NY 11730-2522
(631) 863-3000
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
1136564
NY
Other
Enumeration date
10/28/2025
Last updated
10/28/2025
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