MEDICARE: MISS HADASSA BERGER BCBA

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	103K00000X	Behavior Analyst	12261326	NY

General Provider Information

NPI Number	:	1891498762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS HADASSA BERGER BCBA

Provider Business Mailing Address
First Line	:	1353 49TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-3180
Country	:	US
Telephone Number	:	718-928-5320
Fax Number	:

Provider Business Practice Location Address
First Line	:	4502 13TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-6625
Country	:	US
Telephone Number	:	718-928-5320
Fax Number	:

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

Provider Enumeration Date	:	03/22/2023
Last Update Date	:	03/22/2023

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