Individual
LINDSAY RAY BERGMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LISW-S, LCSW
Contact information
Practice address
190 WILSON RD, COLLINS, MS 39428-6030
(601) 408-9616
Mailing address
7239 FERNBANK AVE, CINCINNATI, OH 45233-1011
(601) 408-9616
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
1041C0700X
Clinical Social Worker
C6874
MS
1041C0700X
Clinical Social Worker
Primary
I1450832SUPV
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0173042
—
OH
Enumeration date
05/23/2007
Last updated
10/11/2022
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