Healthcare Provider Details

I. General information

NPI: 1346796414
Provider Name (Legal Business Name): ERIK BERG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2016
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 5TH ST
BERKELEY CA
94710-1713
US

IV. Provider business mailing address

1530 5TH ST
BERKELEY CA
94710-1713
US

V. Phone/Fax

Practice location:
  • Phone: 510-679-1002
  • Fax:
Mailing address:
  • Phone: 510-679-1002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY34205
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: