Danielle Rae Bergeron Ingram, LPC, M.S., QDDP

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

047.0111914 Issued in VT

Practice address

78 S Main St
Rutland, VT 05701-4591

Phone

(802) 775-0828

NPI assigned

Oct 23, 2014

Sex

Female

Sole proprietor

Yes

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Mar 1, 2024 through Mar 1, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Dec 21, 2015.

{
    "created_epoch": "1414022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1450656000000",
    "number": "1669877452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "78 S MAIN ST",
            "city": "RUTLAND",
            "state": "VT",
            "postal_code": "057014591",
            "telephone_number": "802-775-0828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "78 S MAIN ST",
            "city": "RUTLAND",
            "state": "VT",
            "postal_code": "057014591",
            "telephone_number": "802-775-0828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERGERON INGRAM",
        "first_name": "DANIELLE",
        "middle_name": "RAE",
        "credential": "LPC, M.S., QDDP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-10-23",
        "last_updated": "2015-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "VT",
            "license": "047.0111914",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Betty Lou Bell, RBT
• John D Bell, OD
• Allison Elizabeth Bembe, OTR/L
• Patrick C Benini, CMHC
• Brandy Bennick, LICSW
• Hayley Bertrand
• Victoria Jane Bessinger, M.D.
• Beverly J. Roseberry, MD, PC
• Bilancia Inc
• Daniel T Biles, MD

• All providers in Rutland, VT
• Clinical Psychologist in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.