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General NPI Number Information
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NPI Number | 1609738426
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Entity Type | Individual
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Provider Name | MADISON ALEICE BERG
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Gender | Female
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Dates
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Enumeration Date | 12/01/2025
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 10003 WEBSTER RD
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City | CAMDEN ON GAULEY
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State | WV
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Zip | 26208-7713
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Country | US
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Telephone | 304-226-5725
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Fax | 304-226-3274
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Provider Business Mailing Address
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Address Line | 7 CHURCH ST
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City | RICHWOOD
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State | WV
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Zip | 26261-1211
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Country | US
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Telephone | 304-226-5725
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Fax | 304-226-3274
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | BP00947015
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License Number State | WV
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