MEDICARE: DR. JOAN ELDODT BERGER PHD

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	103T00000X	Psychologist	1472	TX

General Provider Information

NPI Number	:	1548448699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOAN ELDODT BERGER PHD

Provider Business Mailing Address
First Line	:	6390 LBJ FREEWAY
Second Line	:	SUITE 107
City	:	DALLAS
State	:	TX
Zip	:	75240-6442
Country	:	US
Telephone Number	:	972-239-9014
Fax Number	:	972-239-4760

Provider Business Practice Location Address
First Line	:	6390 LBJ FREEWAY
Second Line	:	SUITE 107
City	:	DALLAS
State	:	TX
Zip	:	75240-6442
Country	:	US
Telephone Number	:	972-239-9014
Fax Number	:	972-239-4760

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

Provider Enumeration Date	:	01/31/2008
Last Update Date	:	01/31/2008

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