Individual
MS. DOROTHY JOAN BERGOLD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
385 BROADWAY, REVERE, MA 02151-3033
(781) 485-1000
Mailing address
13 HERSAM ST, STONEHAM, MA 02180-2441
(781) 438-9006
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
105125
MA
Other
Enumeration date
09/11/2018
Last updated
09/11/2018
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