Healthcare Provider Details

I. General information

NPI: 1730652116
Provider Name (Legal Business Name): BRIAN L BERGER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2019
Last Update Date: 01/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 SE CENTRAL PKWY
STUART FL
34994-3970
US

IV. Provider business mailing address

616 SE CENTRAL PKWY
STUART FL
34994-3970
US

V. Phone/Fax

Practice location:
  • Phone: 772-320-5885
  • Fax:
Mailing address:
  • Phone: 561-818-8054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH12885
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: