Healthcare Provider Details

I. General information

NPI: 1033294509
Provider Name (Legal Business Name): PAUL S. D. BERG PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 29TH ST STE 315
OAKLAND CA
94609-3548
US

IV. Provider business mailing address

400 29TH ST STE 315
OAKLAND CA
94609-3548
US

V. Phone/Fax

Practice location:
  • Phone: 510-893-3413
  • Fax: 510-893-3435
Mailing address:
  • Phone: 510-893-3413
  • Fax: 510-893-3435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPSY2811
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: