Healthcare Provider Details

I. General information

NPI: 1104152453
Provider Name (Legal Business Name): STEVEN GARY BERGER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2009
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 VILLAGE TRCE NE STE 100
MARIETTA GA
30067-4069
US

IV. Provider business mailing address

600 VILLAGE TRCE NE STE 100
MARIETTA GA
30067-4069
US

V. Phone/Fax

Practice location:
  • Phone: 770-971-3303
  • Fax: 770-971-3314
Mailing address:
  • Phone: 770-971-3303
  • Fax: 770-971-3314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY002956
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: