Theresa Bergold, LMSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

096848 Issued in NY

Practice address

161 Lake Shore Rd
Lake Ronkonkoma, NY 11779-3182

Phone

(631) 471-5666

NPI assigned

Aug 1, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

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.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Central Nassau Guidance and Counseling Services, Inc.Group PAC ID 6406747401, 32 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Central Nassau Guidance & Counseling Services, Inc.

  • Community/Behavioral Health Agency
  • Hicksville, NY
  • NPI 1114928462

  Addiction (Substance Use Disorder)

  Medicare reassignment Care Compare group NPD
• Mental Health Specialty Group PA

  • Mental Health Counselor
  • Durham, NC
  • NPI 1801472634

  NY

  Medicare reassignment NPD
• Brave Medical P.C.

  • Community/Behavioral Health Agency
  • Yonkers, NY
  • NPI 1902415318
  Medicare reassignment

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

{
    "created_epoch": "1501545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722556800000",
    "number": "1831613868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 RAILROAD AVE APT 4",
            "city": "BETHPAGE",
            "state": "NY",
            "postal_code": "117143000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "161 LAKE SHORE RD",
            "city": "LAKE RONKONKOMA",
            "state": "NY",
            "postal_code": "117793182",
            "telephone_number": "631-471-5666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERGOLD",
        "first_name": "THERESA",
        "name_prefix": "Ms.",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-01",
        "last_updated": "2024-08-02",
        "certification_date": "2024-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "096848",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle Bagliore
• Julianne Bartlett, M.ED., CAS
• Carmela Bayer, PA-C
• Barbara A Becker, LCSW
• Linda Jean Bergman
• Ronald R Bernardini, DC
• Nicole Biondi, RN
• Edjeanine Boucicault, LPN
• Ryan Joseph Branigan, MA-SLP
• Tracy K Brooks, O.D.

• Clinical Social Worker in Lake Ronkonkoma, NY
• Providers in Lake Ronkonkoma, 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 2, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.