Healthcare Provider Details

I. General information

NPI: 1548283286
Provider Name (Legal Business Name): MARGARET W BERTON PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 10/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 LYNN BATTS LN SUITE 11
SAN ANTONIO TX
78218-3079
US

IV. Provider business mailing address

21 LYNN BATTS SUITE 11
SAN ANTONIO TX
78218-3078
US

V. Phone/Fax

Practice location:
  • Phone: 210-829-1994
  • Fax: 210-829-8788
Mailing address:
  • Phone: 210-829-1994
  • Fax: 210-829-8788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number6416
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number2-5609
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: