Lindsay Ray Bergman, LISW-S, LCSW
Individual provider Active NPI Clinical Social Worker · Collins, MS
NPI 1710197173 · NPPES record last updated Oct 11, 2022
Key facts
- NPI
- 1710197173
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- I1450832SUPV (OH)
- Practice address
- 190 Wilson Rd
Collins, MS 39428-6030 - Phone
- (601) 408-9616
- NPI assigned
- May 23, 2007
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C6874 | MS | MD | Clinical Social Worker |
| I1450832SUPV | OH | MD | Clinical Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | |||
| Clinical Social Worker | 1041C0700X | C6874 | MS | |
| Clinical Social Worker | 1041C0700X | I1450832SUPV | OH | Yes |
Addresses
Primary practice location
190 Wilson Rd
Collins, MS 39428-6030
Mailing address
7239 Fernbank Ave
Cincinnati, OH 45233-1011
Phone (601) 408-9616
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0173042 | Medicaid | OH |
Other providers in Collins, MS
- Alice Annette Ashley
- Elexis Barnes I
- Neshobi Barnes
- Roger Kyle Bass
- Jason Gregory Beasley
- Dashara P Booth
- Cody Lee Broom
- Andrea Maureen Bruce
- Karen H Bruce
- Linda B Buffington
All providers in Collins, MS · Clinical Social Worker in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 11, 2022. 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.