Provider Demographics
NPI:1679718936
Name:BERGMANN, ELEANOR BOYD (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ELEANOR
Middle Name:BOYD
Last Name:BERGMANN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:ELEANOR
Other - Middle Name:HALLA
Other - Last Name:BOYD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:90 MADISON ST STE 504
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-5414
Mailing Address - Country:US
Mailing Address - Phone:303-562-6629
Mailing Address - Fax:
Practice Address - Street 1:90 MADISON ST STE 504
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-5414
Practice Address - Country:US
Practice Address - Phone:303-562-6629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-15
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical