Healthcare Provider Details

I. General information

NPI: 1992177505
Provider Name (Legal Business Name): DORITA S. BERGER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2015
Last Update Date: 10/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1657 SNOWMASS WAY
DURHAM NC
27713-4514
US

IV. Provider business mailing address

1657 SNOWMASS WAY
DURHAM NC
27713-4514
US

V. Phone/Fax

Practice location:
  • Phone: 203-984-7664
  • Fax:
Mailing address:
  • Phone: 203-984-7664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: DR. DORITA S BERGER
Title or Position: BOARD CERTIFIED MUSIC THERAPIST
Credential: PHD, MT-BC, LCAT
Phone: 203-984-7664