Provider Demographics
NPI:1053091835
Name:BERGNER, DEBORAH D'AMICO (LCMSW)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:D'AMICO
Last Name:BERGNER
Suffix:
Gender:F
Credentials:LCMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 KETTLE POND DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02879-5465
Mailing Address - Country:US
Mailing Address - Phone:401-954-5076
Mailing Address - Fax:
Practice Address - Street 1:345 KETTLE POND DR
Practice Address - Street 2:
Practice Address - City:SOUTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02879-5465
Practice Address - Country:US
Practice Address - Phone:401-954-5076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICSW03293104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker