Healthcare Provider Details

I. General information

NPI: 1760879407
Provider Name (Legal Business Name): DUSTIN BERGER B.S., CAP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2015
Last Update Date: 04/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 S ORANGE BLOSSOM TRL SUITE 229
ORLANDO FL
32805-3118
US

IV. Provider business mailing address

750 S ORANGE BLOSSOM TRL SUITE 229
ORLANDO FL
32805-3118
US

V. Phone/Fax

Practice location:
  • Phone: 407-745-5022
  • Fax: 407-601-4302
Mailing address:
  • Phone: 407-745-5022
  • Fax: 407-601-4302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number000182
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: