MEDICARE: DR. GAYLE R BERG 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	103TC1900X	Counseling Psychologist	007919-1	NY

General Provider Information

NPI Number	:	1598750796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GAYLE R BERG PH.D.

Provider Business Mailing Address
First Line	:	70 GLEN COVE RD
Second Line	:	SUITE 209
City	:	ROSLYN HTS
State	:	NY
Zip	:	11577-1726
Country	:	US
Telephone Number	:	516-621-0888
Fax Number	:	516-626-1843

Provider Business Practice Location Address
First Line	:	70 GLEN COVE RD
Second Line	:	SUITE 209
City	:	ROSLYN HTS
State	:	NY
Zip	:	11577-1726
Country	:	US
Telephone Number	:	516-621-0888
Fax Number	:	516-626-1843

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

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	06/19/2011

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