MEDICARE: MRS. NICOLE S BERGER PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A0832	OTHER	MD	MARYLAND BOARD OF EXAMINERS OF PSYCHOLOGISTS

General Provider Information

NPI Number	:	1770207151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NICOLE S BERGER PSYD

Provider Business Mailing Address
First Line	:	2722 WOODCOURT RD
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21209-2522
Country	:	US
Telephone Number	:	954-296-1838
Fax Number	:

Provider Business Practice Location Address
First Line	:	1190 WINTERSON RD STE 160
Second Line	:
City	:	LINTHICUM
State	:	MD
Zip	:	21090-2245
Country	:	US
Telephone Number	:	410-684-3806
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2022
Last Update Date	:	09/29/2022

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