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Deactivated NPI 1831602218 Deactivated / Inactive NPI Female Practitioner

Amy Bergstrom , LPC

Counselor - Professional • Wayne, PA

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Amy Bergstrom has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date November 08, 2017
NPI Deactivation Date November 08, 2017
Total Practice Duration ~1 Years of Practice (2017 – 2017)

Professional Overview & Biography Verified Profile Summary

Amy Bergstrom, LPC was a registered Counselor - Professional practicing in Wayne, PA. Throughout an active medical career spanning 1 years, Amy Bergstrom provided care at the practice location at 300 N WAYNE AVE APT 5 until profile deactivation on 2017-11-08.

Practice Location & Contact Primary Location

Practice Address

300 N Wayne Ave Apt 5

Wayne, PA 190873239

Telephone 8155752014

Specialty Benchmarks & Practice Insights

Comparative analytics for Counselor - Professional in Wayne, PA

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 24.0 Yrs
State Avg: 13.9 Yrs
Regional Practice Density
29 Specialists

Practicing in Wayne, PA (9514 Statewide)

Telehealth Adoption Rate
10.3% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

CMS Verified: 2023-10-31
Counselor - Professional Primary Specialty

NUCC Taxonomy Code: 101YP2500X

State License PA PC012237

Definition to come...

Counselor - Mental Health

NUCC Taxonomy Code: 101YM0800X

Definition to come...

Counselor - Professional

NUCC Taxonomy Code: 101YP2500X

State License MD LC9490

Definition to come...

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

13 Historical Events
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Updated Practice Location October 31, 2023

Registered at 300 N WAYNE AVE APT 5, WAYNE, PA 190873239 (Tel: 8155752014)

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Updated Business Mailing Address October 31, 2023

Registered at 300 N WAYNE AVE APT 5, WAYNE, PA 190873239 (Tel: 8155752014)

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Medical Taxonomy / Specialty Registered (Primary Specialty) October 31, 2023

Counselor

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Updated Practice Location February 01, 2023

Registered at 1777 SENTRY PKWY W STE 300, BLUE BELL, PA 194222211 (Tel: 2157677096)

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Provider Name / Credentials Updated February 01, 2023

Recorded as AMY BERGSTROM, LPC

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Medical Taxonomy / Specialty Registered (Primary Specialty) February 01, 2023

Counselor (License #PC012237 in PA)

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NPI Profile Reactivated November 14, 2017

Record officially reactivated for active practice on November 14, 2017

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Updated Practice Location November 14, 2017

Registered at 5022 CAMPBELL BLVD STE L, NOTTINGHAM, MD 212364969 (Tel: 4434421568)

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Updated Business Mailing Address November 14, 2017

Registered at 5022 CAMPBELL BLVD STE L, NOTTINGHAM, MD 212364969

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Provider Name / Credentials Updated November 14, 2017

Recorded as AMY BERGSTROM, LGPC

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Medical Taxonomy / Specialty Registered (Primary Specialty) November 14, 2017

Counselor

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NPI Profile Deactivated November 08, 2017

Record deactivated on November 08, 2017

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Initial NPI Registration & Enumeration November 08, 2017

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1831602218
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: November 08, 2017
Last Update: October 31, 2023
Deactivation Date: November 08, 2017
Sole Proprietor: Yes

Mailing Address

300 N Wayne Ave Apt 5

Wayne, PA 190873239

Phone: 8155752014

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

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