MEDICARE: DR. STEVEN GARY BERGER PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC2200X	Clinical Child & Adolescent Psychologist	PSY002956	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104152453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN GARY BERGER PH.D.

Provider Business Mailing Address
First Line	:	4939 LOWER ROSWELL RD
Second Line	:	BLDG B - 202
City	:	MARIETTA
State	:	GA
Zip	:	30068-4338
Country	:	US
Telephone Number	:	770-971-3303
Fax Number	:	770-971-3314

Provider Business Practice Location Address
First Line	:	4939 LOWER ROSWELL RD
Second Line	:	BLDG B - 202
City	:	MARIETTA
State	:	GA
Zip	:	30068-4338
Country	:	US
Telephone Number	:	770-971-3303
Fax Number	:	770-971-3314

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2009
Last Update Date	:	04/16/2026

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