MEDICARE: DR. JILL M BERGER PHD PA

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	103TC0700X	Clinical Psychologist	PY7392	FL

General Provider Information

NPI Number	:	1265590954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JILL M BERGER PHD PA

Provider Business Mailing Address
First Line	:	5008 HERON PL
Second Line	:
City	:	COCONUT CREEK
State	:	FL
Zip	:	33073-2412
Country	:	US
Telephone Number	:	954-401-4589
Fax Number	:

Provider Business Practice Location Address
First Line	:	3836 W HILLSBORO BLVD
Second Line	:
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33442-9413
Country	:	US
Telephone Number	:	954-401-4589
Fax Number	:

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

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	08/06/2007

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