Active NPI
Jennifer Lynn Bergmann, PSY.D.
- Clinical Psychologist
- San Francisco, CA
National Provider Identifier
1548573645
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 022176
- Practice address
- 4155 Cesar Chavez St
#6
San Francisco, CA 94131-1957 - Phone
- (214) 629-5906
- NPI assigned
- Jul 17, 2010
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | |||
| Addiction (Substance Use Disorder) Psychologist | 103TA0400X | |||
| Clinical Psychologist | 103TC0700X | 022176 | NY | Primary |
Addresses
Primary practice location
4155 Cesar Chavez St
#6
San Francisco, CA 94131-1957
Mailing address
1 Charcoal Rd
Norwalk, CT 06854-4013
Phone (214) 629-5906
Other practice location 1
950 Campbell Ave
West Haven, CT 06516-2770
Phone (475) 439-3333
Other names 1
- Dr. Jennifer Lynn Coughlin
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 |
|---|---|---|---|
| 022176 | NY | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1279324800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1562544000000",
"number": "1548573645",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 CHARCOAL RD",
"city": "NORWALK",
"state": "CT",
"postal_code": "068544013",
"telephone_number": "214-629-5906"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4155 CESAR CHAVEZ ST",
"address_2": "#6",
"city": "SAN FRANCISCO",
"state": "CA",
"postal_code": "941311957",
"telephone_number": "214-629-5906"
}
],
"practiceLocations": [
{
"address_1": "950 Campbell Ave",
"address_purpose": "LOCATION",
"city": "West Haven",
"state": "CT",
"postal_code": "065162770",
"country_code": "US",
"telephone_number": "475-439-3333",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BERGMANN",
"first_name": "JENNIFER",
"middle_name": "LYNN",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-07-17",
"last_updated": "2019-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TA0400X",
"taxonomy_group": "",
"desc": "Psychologist, Addiction (Substance Use Disorder)",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "022176",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "JENNIFER",
"last_name": "COUGHLIN",
"middle_name": "LYNN",
"prefix": "DR.",
"credential": "PSYD",
"code": "1",
"type": "Former Name"
}
]
}Other providers in San Francisco, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.