Healthcare Provider Details

I. General information

NPI: 1609738426
Provider Name (Legal Business Name): MADISON ALEICE BERG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10003 WEBSTER RD
CAMDEN ON GAULEY WV
26208-7713
US

IV. Provider business mailing address

7 CHURCH ST
RICHWOOD WV
26261-1211
US

V. Phone/Fax

Practice location:
  • Phone: 304-226-5725
  • Fax: 304-226-3274
Mailing address:
  • Phone: 304-226-5725
  • Fax: 304-226-3274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberBP00947015
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: