Provider Demographics
NPI:1669518924
Name:BEREGNOI, IGOR (PHD, LPC)
Entity type:Individual
Prefix:
First Name:IGOR
Middle Name:
Last Name:BEREGNOI
Suffix:
Gender:M
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1090 GREEN CHAPEL RD.
Mailing Address - Street 2:
Mailing Address - City:CRESCO
Mailing Address - State:PA
Mailing Address - Zip Code:18326
Mailing Address - Country:US
Mailing Address - Phone:570-730-6399
Mailing Address - Fax:
Practice Address - Street 1:2083 CENTER AVE
Practice Address - Street 2:3H
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-7400
Practice Address - Country:US
Practice Address - Phone:201-585-2334
Practice Address - Fax:201-585-2807
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJPC00194101YP2500X
NY8933101YA0400X
PAPS-015152103TC0700X
DEB1-000542103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical