Provider Demographics
NPI:1548301666
Name:BERGERON, RACHEL LUCILLE (PHD)
Entity type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:LUCILLE
Last Name:BERGERON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:RACHEL
Other - Middle Name:BERGERON
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:441 ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-6217
Mailing Address - Country:US
Mailing Address - Phone:203-777-5049
Mailing Address - Fax:203-281-0640
Practice Address - Street 1:441 ORANGE ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-6217
Practice Address - Country:US
Practice Address - Phone:203-777-5049
Practice Address - Fax:203-281-0640
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000958103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical