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: 10/11/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1918 UNIVERSITY AVE # 2B
BERKELEY CA
94704
US

IV. Provider business mailing address

1918 UNIVERSITY AVE STE 2B
BERKELEY CA
94704-3264
US

V. Phone/Fax

Practice location:
  • Phone: 510-548-9716
  • Fax:
Mailing address:
  • Phone: 510-841-1262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberD1204909
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY34205
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: