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General NPI Number Information
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NPI Number | 1255628780
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Entity Type | Individual
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Provider Name | JENNIFER A BERG PSYD
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Gender | Female
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Dates
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Enumeration Date | 07/05/2011
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Last Update Date | 01/09/2020
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Provider Practice Location Address
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Address Line | 30011 IVY GLENN DR STE 206
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City | LAGUNA NIGUEL
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State | CA
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Zip | 92677-5017
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Country | US
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Telephone | 949-371-7070
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Fax |
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Provider Business Mailing Address
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Address Line | 33615 AVENIDA CAPRI
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City | DANA POINT
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State | CA
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Zip | 92629-1616
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Country | US
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Telephone | 949-290-9077
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY30317
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License Number State | CA
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