Michael Alvin Bergondo, MSW
Individual provider Active NPI Clinical Social Worker · La Junta, CO
NPI 1629320239 · NPPES record last updated Oct 5, 2012
Key facts
- NPI
- 1629320239
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 992947 (CO)
- Practice address
- 1100 Carson Ave
Suite 104
La Junta, CO 81050-2751 - Phone
- (719) 383-5195
- NPI assigned
- Oct 5, 2012
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 992947 | CO | MD | Clinical Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 992947 | CO | Yes |
Addresses
Primary practice location
1100 Carson Ave
Suite 104
La Junta, CO 81050-2751
Mailing address
2135 Fowler St
Canon City, CO 81212-3927
Phone (719) 269-9296
Other providers in La Junta, CO
- Theresa Marie Bauer
- Jill Renee Bauserman
- Vernice Ann R Bautista
- Janice Baylor
- Mary Jean Berg
- Kristin Leaann Bickel
- Parker Alan Bickel
- Madhuri Bobba
- Joyce E. Bond
- Joel Scott Bonzo
All providers in La Junta, CO · Clinical Social Worker in Colorado
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 5, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.