=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871825075
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PAUL S.D. BERG, PH.D. & ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/12/2010
-----------------------------------------------------
Last Update Date | 02/12/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 389 30TH ST SUITE 101
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94609-3402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-893-3413
-----------------------------------------------------
Fax | 510-893-3435
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 389 30TH ST SUITE 101
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94609-3402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-893-3413
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHOLOGIST
-----------------------------------------------------
Name | DR. PAUL S D BERG
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 510-893-3413
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | PSY2811
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------