Healthcare Provider Details

I. General information

NPI: 1437075504
Provider Name (Legal Business Name): BERG PSYCHIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11782 S 51ST DR
LAVEEN AZ
85339-4514
US

IV. Provider business mailing address

11782 S 51ST DR
LAVEEN AZ
85339-4514
US

V. Phone/Fax

Practice location:
  • Phone: 608-332-3229
  • Fax: 602-584-6594
Mailing address:
  • Phone: 608-332-3229
  • Fax: 602-584-6594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MARY JANE BENITO BERG
Title or Position: OWNER/PMHNP
Credential: PMHNP-BC
Phone: 608-332-3229