Healthcare Provider Details

I. General information

NPI: 1265175459
Provider Name (Legal Business Name): CHERYLYNNE BERGER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2022
Last Update Date: 04/15/2022
Certification Date: 04/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 E GREEN ST STE 203
PASADENA CA
91106-2401
US

IV. Provider business mailing address

2439 HIGHLAND AVE
ALTADENA CA
91001-2550
US

V. Phone/Fax

Practice location:
  • Phone: 626-710-8036
  • Fax:
Mailing address:
  • Phone: 626-710-8036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS10957
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: