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General NPI Number Information
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NPI Number | 1326185745
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Entity Type | Organization
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Legal Business Name | MARK G. BERGER, PH.D.
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2101 EXECUTIVE DR TOWER BOX 44
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City | HAMPTON
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State | VA
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Zip | 23666-2404
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Country | US
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Telephone | 757-827-9650
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Fax | 757-827-9651
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Provider Business Mailing Address
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Address Line | 2101 EXECUTIVE DR TOWER BOX 44
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City | HAMPTON
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State | VA
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Zip | 23666-2404
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Country | US
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Telephone | 757-827-9650
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Fax | 757-827-9651
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. BRENDA HEARN
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Credential |
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Telephone | 757-827-9650
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0810000978
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License Number State | VA
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