Nicole Bergamo Isbell, PH.D., LP

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6301019415 Issued in MI

Practice address

3005 Boardwalk St Ste 201
Ann Arbor, MI 48108-5218

Phone

(734) 222-9277

NPI assigned

Aug 21, 2019

Last updated

Oct 9, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other names 1

• Nicole Marie Bergamo Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• 2Besuccessful

  dba Sunfield Center

  • Adolescent and Children Mental Health Clinic/Center
  • Ann Arbor, MI
  • NPI 1932597309
  NPD (past)

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

{
    "created_epoch": "1566345600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728432000000",
    "number": "1588211874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3005 BOARDWALK ST STE 201",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481085218",
            "telephone_number": "734-222-9277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3005 BOARDWALK ST STE 201",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481085218",
            "telephone_number": "734-222-9277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ISBELL",
        "first_name": "NICOLE",
        "middle_name": "BERGAMO",
        "name_prefix": "Dr.",
        "credential": "PH.D., LP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-21",
        "last_updated": "2024-10-09",
        "certification_date": "2024-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6301019415",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6362001372",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6351004559",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301019415",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "BERGAMO",
            "middle_name": "MARIE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Caroline J Irving
• Lisa Ann Irwin, MD
• Madison Irwin, PHARMD
• Brynna Isaac
• Jacqueline Marie Isaac, MS, CGC
• Ellery Isenstein
• Hamza Ishaq
• Martin Keith Ishikawa, M.D.
• Ismail B. Sendi, MD, PC (New Oakland Family Centers)
• Maye Ismail, RN

• Clinical Psychologist in Ann Arbor, MI
• Providers in Ann Arbor, MI by specialty
• Clinical Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.