Active NPI
Mary Kathryn Bergeron, LCSW
- Clinical Social Worker
- Redding, CA
National Provider Identifier
1427220516
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 14222
- Practice address
- 3400 Knighton Rd
Redding, CA 96002-9498 - Phone
- (530) 224-3822
- NPI assigned
- Mar 28, 2008
- Last updated
- Sep 10, 2013
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 14222 | CA | Primary |
Addresses
Primary practice location
3400 Knighton Rd
Redding, CA 96002-9498
Mailing address
3400 Knighton Rd
Redding, CA 96002-9498
Phone (530) 224-3822
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14222 | CA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1206662400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1378771200000",
"number": "1427220516",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3400 KNIGHTON RD",
"city": "REDDING",
"state": "CA",
"postal_code": "960029498",
"telephone_number": "530-224-3822"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3400 KNIGHTON RD",
"city": "REDDING",
"state": "CA",
"postal_code": "960029498",
"telephone_number": "530-224-3822"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERGERON",
"first_name": "MARY",
"middle_name": "KATHRYN",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-03-28",
"last_updated": "2013-09-10",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "14222",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Redding, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.