=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932118197
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEBRA BERGER LERNER LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1918 BELLMORE AVE SUITE A
-----------------------------------------------------
City | NORTH BELLMORE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11710-5641
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-643-9295
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1201 DOUGLAS AVE
-----------------------------------------------------
City | WANTAGH
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11793-1732
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-643-9295
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | R050893-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------