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General NPI Number Information
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NPI Number | 1871663658
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Entity Type | Organization
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Legal Business Name | DIVERSIFIED PSYCHCARE ASSOCIATES, P.C.
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 234 S BRYN MAWR AVE SUITE 202
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City | BRYN MAWR
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State | PA
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Zip | 19010-2133
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Country | US
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Telephone | 610-527-6555
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Fax | 610-527-7248
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Provider Business Mailing Address
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Address Line | PO BOX 693
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City | BRYN MAWR
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State | PA
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Zip | 19010-0693
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Country | US
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Telephone | 610-527-6555
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Fax | 610-527-7248
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRUCE J. BERG
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Credential | M.D.
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Telephone | 610-527-6555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD-037544-E
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License Number State | PA
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