1487453163 NPI number — LAKE COUNTY OFFICE OF EDUCATION

Table of content: DALONDRIC RACEL BERGEN SR. LCPC (NPI 1750662649)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487453163 NPI number — LAKE COUNTY OFFICE OF EDUCATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAKE COUNTY OFFICE OF EDUCATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487453163
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/14/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1152 S MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKEPORT
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95453-5517
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-262-4110
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13050 HIGH VALLEY ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEARLAKE OAKS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-998-3387
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/13/2025

Additional Information

Authorized Official

Authorized Official Last Name:
SHANNON
Authorized Official First Name:
DENISE
Authorized Official Middle Name:
Authorized Official Title or Position:
ASSISTANT SUPERINTENDENT - FISCAL
Authorized Official Telephone Number:
707-262-4100

Provider Taxonomy Codes

  • Taxonomy code: 251300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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