John H Bergeron, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

8494 Issued in MA

Practice address

1679 Massachusetts Ave
First Floor
Cambridge, MA 02138-1807

Phone

(617) 441-8008

Fax

(617) 441-3030

NPI assigned

Jun 8, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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 Jan 29, 2016 through Jan 29, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Two Brattle Center, P.C.

  • Psychiatry Physician
  • Cambridge, MA
  • NPI 1396792628
  NPD (past)

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

{
    "created_epoch": "1149724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1250812800000",
    "number": "1679513246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1679 MASSACHUSETTS AVE",
            "address_2": "FIRST FLOOR",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "021381807",
            "telephone_number": "617-441-8008",
            "fax_number": "617-441-3030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1679 MASSACHUSETTS AVE",
            "address_2": "FIRST FLOOR",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "021381807",
            "telephone_number": "617-441-8008",
            "fax_number": "617-441-3030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERGERON",
        "first_name": "JOHN",
        "middle_name": "H",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-08",
        "last_updated": "2009-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MA",
            "license": "8494",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maya Berdzenishvili, M.D.
• Alexandra R Berg, MD
• Erik Victor Berg, M.D.
• Allison H Berger, PH.D.
• Harvey J Berger, M.D.
• Melissa H Bergman, MD
• Anna Berkenblit, M.D.
• Joseph Berlin
• Cynthia Joy Berman II, PSY.D.
• Lauren C. Berman, M.S.W., L.I.C.S.W.

• Clinical Psychologist in Cambridge, MA
• Providers in Cambridge, MA by specialty
• Clinical Psychologist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2009; 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.