Dorothy Joan Bergold, LICSW

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

105125 Issued in MA

Practice address

385 Broadway
Revere, MA 02151-3033

Phone

(781) 485-1000

NPI assigned

Sep 11, 2018

Sex

Female

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)

Not enrolled

State licenses

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

{
    "created_epoch": "1536624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536624000000",
    "number": "1902389463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13 HERSAM ST",
            "city": "STONEHAM",
            "state": "MA",
            "postal_code": "021802441",
            "telephone_number": "781-438-9006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "385 BROADWAY",
            "city": "REVERE",
            "state": "MA",
            "postal_code": "021513033",
            "telephone_number": "781-485-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERGOLD",
        "first_name": "DOROTHY",
        "middle_name": "JOAN",
        "name_prefix": "Ms.",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-09-11",
        "last_updated": "2018-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "MA",
            "license": "105125",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Primary Care Clinic/Center in Revere, MA
• Providers in Revere, MA by specialty
• Primary Care Clinic/Center in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2018; 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.