MEDICARE: CHRISTY BERGER

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	247200000X	Other Technician
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1558710806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTY BERGER

Provider Business Mailing Address
First Line	:	45726 LAKEVIEW CT
Second Line	:	APT. 15206
City	:	NOVI
State	:	MI
Zip	:	48377-3836
Country	:	US
Telephone Number	:	810-650-2012
Fax Number	:

Provider Business Practice Location Address
First Line	:	45726 LAKEVIEW CT
Second Line	:	APT. 15206
City	:	NOVI
State	:	MI
Zip	:	48377-3836
Country	:	US
Telephone Number	:	810-650-2012
Fax Number	:

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

Provider Enumeration Date	:	06/08/2016
Last Update Date	:	02/16/2017

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Directions to “ CHRISTY BERGER ” Practice Location

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