Richard A. Bergman, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PS-003590-L Issued in PA

Practice address

620 E Willow Grove Ave
Wyndmoor, PA 19038-7949

Phone

(215) 233-4350

Fax

(215) 233-4404

NPI assigned

Nov 27, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 1, 2022 through Jan 1, 2028

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Vanguard Psychological Associates, P.C.

  • Psychologist
  • Wyndmoor, PA
  • NPI 1194884015
  NPD (past) Authorized official

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

{
    "created_epoch": "1164585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1366518037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 E WILLOW GROVE AVE",
            "city": "WYNDMOOR",
            "state": "PA",
            "postal_code": "190387949",
            "telephone_number": "215-233-4350",
            "fax_number": "215-233-4404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 E WILLOW GROVE AVE",
            "city": "WYNDMOOR",
            "state": "PA",
            "postal_code": "190387949",
            "telephone_number": "215-233-4350",
            "fax_number": "215-233-4404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERGMAN",
        "first_name": "RICHARD",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "PA",
            "license": "PS-003590-L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristen Lea Badawy, FNP-C
• Samy Badawy, M.D.
• Simeon L Bardin, MD
• Neal Edward Beatus, M.S.S., L.C.S.W.
• William E. Benson, MD
• Maria J Bertucci, M.D.
• Thomas W.C. Blash, PSY D
• Jasmine Boone
• Michael William Braun, PT
• Elizabeth C. Brooks, JD IBCLC

• Psychologist in Wyndmoor, PA
• Providers in Wyndmoor, PA by specialty
• Psychologist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.