Active NPI
Tammy Lee Bergen
- Pastoral Counselor
- Plattsburgh, NY
National Provider Identifier
1265907943
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pastoral Counselor
- License
- P13611
- Practice address
- 22 US Oval Ste 100
Plattsburgh, NY 12903-5901 - Phone
- (518) 578-1442
- NPI assigned
- Oct 9, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pastoral Counselor | 101YP1600X | P13611 | NY | Primary |
Addresses
Primary practice location
22 US Oval Ste 100
Plattsburgh, NY 12903-5901
Mailing address
22 US Oval Ste 100
Plattsburgh, NY 12903-5901
Phone (518) 578-1442
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P13611 | NY | MD | Pastoral Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1539043200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1539043200000",
"number": "1265907943",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22 US OVAL STE 100",
"city": "PLATTSBURGH",
"state": "NY",
"postal_code": "129035901",
"telephone_number": "518-578-1442"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22 US OVAL STE 100",
"city": "PLATTSBURGH",
"state": "NY",
"postal_code": "129035901",
"telephone_number": "518-578-1442"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERGEN",
"first_name": "TAMMY",
"middle_name": "LEE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-10-09",
"last_updated": "2018-10-09",
"status": "A"
},
"taxonomies": [
{
"code": "101YP1600X",
"taxonomy_group": "",
"desc": "Counselor, Pastoral",
"state": "NY",
"license": "P13611",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Plattsburgh, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.