Provider Demographics
NPI:1487318820
Name:BERGMAN, DAVID RINGVIK
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:RINGVIK
Last Name:BERGMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 PEGASUS ST STE 200
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-5088
Mailing Address - Country:US
Mailing Address - Phone:207-373-0620
Mailing Address - Fax:
Practice Address - Street 1:62 PEGASUS ST STE 200
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-5088
Practice Address - Country:US
Practice Address - Phone:207-373-0620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-22
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
MEMC247631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician