MEDICARE: GINNY BERG LCSW

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	1041C0700X	Clinical Social Worker	SW 3874	FL

General Provider Information

NPI Number	:	1306832449
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINNY BERG LCSW

Provider Business Mailing Address
First Line	:	1975 E SUNRISE BLVD
Second Line	:	SUITE 614
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33304-1433
Country	:	US
Telephone Number	:	954-767-8263
Fax Number	:	954-467-1417

Provider Business Practice Location Address
First Line	:	1975 E SUNRISE BLVD
Second Line	:	SUITE 614
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33304-1433
Country	:	US
Telephone Number	:	954-767-8263
Fax Number	:	954-467-1417

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

Provider Enumeration Date	:	09/23/2005
Last Update Date	:	07/08/2007

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