Heather A Bergen, LCSW
Individual provider Active NPI Social Worker · Rhinebeck, NY
NPI 1215124367 · NPPES record last updated Jan 26, 2023
Key facts
- NPI
- 1215124367
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Social Worker 104100000X
- License
- 054516-1 (NY)
- Practice address
- 20 Winding Brook LN
Rhinebeck, NY 12572-3427 - Phone
- (845) 220-8602
- NPI assigned
- Oct 2, 2007
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 1996
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
20 Winding Brook Lane
Rhinebeck, NY 12572-3427
20 Winding Brook LN
Rhinebeck, NY 12572-3427
Phone (845) 220-8602
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170329002027 | NY | Practitioner - Clinical Social Worker | 7315222627 |
Reassigns benefits to 1 organization Practice locations: Rhinebeck, NY |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 054516-1 | NY | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Maverick Family Counseling LCSW PLLC | Current |
Accepting new patients |
Locations
404 Zena Rd
Woodstock, NY 12498
Phone (845) 679-5271
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 054516-1 | NY | Yes |
Addresses
Primary practice location
20 Winding Brook LN
Rhinebeck, NY 12572-3427
Mailing address
20 Winding Brook LN
Rhinebeck, NY 12572-3427
Phone (845) 220-8602
Other providers in Rhinebeck, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 26, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.