NPIMap

Organization Active NPI

Kathleen Bergeson, PHD P C

  • Clinical Psychologist
  • Lewisburg, PA
National Provider Identifier
1164634200
Registry record updated Jul 10, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PS015237 Issued in PA
Legal business name
KATHLEEN BERGESON, PHD P C
Practice address
11 Reitz Blvd
Suite 101
Lewisburg, PA 17837-9293
Phone
(570) 524-0881
Fax
(570) 524-9738
NPI assigned
May 3, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kathleen Bergeson, PH D
Title
President
Phone
(570) 524-0881

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X PS015237 PA Primary

Addresses

Primary practice location

11 Reitz Blvd
Suite 101
Lewisburg, PA 17837-9293

Mailing address

11 Reitz Blvd
Suite 101
Lewisburg, PA 17837-9293
Phone (570) 524-0881

National Provider Directory

National Provider Directory

Locations

11 Reitz Blvd
Ste 101
Lewisburg, PA 17837
Phone (570) 524-0881

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184025600000",
    "number": "1164634200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 REITZ BLVD",
            "address_2": "SUITE 101",
            "city": "LEWISBURG",
            "state": "PA",
            "postal_code": "178379293",
            "telephone_number": "570-524-0881",
            "fax_number": "570-524-9738"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 REITZ BLVD",
            "address_2": "SUITE 101",
            "city": "LEWISBURG",
            "state": "PA",
            "postal_code": "178379293",
            "telephone_number": "570-524-0881",
            "fax_number": "570-524-9738"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KATHLEEN BERGESON, PHD P C",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2007-07-10",
        "status": "A",
        "authorized_official_last_name": "BERGESON",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "570-524-0881",
        "authorized_official_credential": "PH D"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "PA",
            "license": "PS015237",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lewisburg, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.