Robert Bergen, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

R025838 Issued in NY

Practice address

11241 Queens Blvd
Suite 203
Forest Hills, NY 11375-5564

Phone

(917) 769-9636

NPI assigned

Aug 14, 2008

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

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1218672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1218672000000",
    "number": "1740436393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "69-34 B 186TH LANE",
            "city": "FRESH MEADOWS",
            "state": "NY",
            "postal_code": "113654434",
            "telephone_number": "917-769-9636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11241 QUEENS BLVD",
            "address_2": "SUITE 203",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "113755564",
            "telephone_number": "917-769-9636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERGEN",
        "first_name": "ROBERT",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-08-14",
        "last_updated": "2008-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "R025838",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Natalie Istam Benyaminov, DNP-FNP
• Jeta Bera, PHARMD
• Christina Berdebes, PHD, LMFT
• Cherrylene Abulag Berdos Ruba, PT
• Dara Bergen, RD
• Lisa Bergenbaum
• Alexander Berger, CASAC
• Chani Berger, R - P.A., CERTIFIED
• Natalya Beria
• Revaz Beridze, DDS

• Clinical Social Worker in Forest Hills, NY
• Providers in Forest Hills, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2008; 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.