MEDICARE: MRS. SARA BERGER 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	021607-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	021607-1	OTHER	NY	NYS LICENSE

General Provider Information

NPI Number	:	1902809668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SARA BERGER LCSW

Provider Business Mailing Address
First Line	:	4525 HENRY HUDSON PARKWAY
Second Line	:	APT 810
City	:	RIVERDALE
State	:	NY
Zip	:	10471-3811
Country	:	US
Telephone Number	:	718-549-2605
Fax Number	:	718-884-1338

Provider Business Practice Location Address
First Line	:	4525 HENRY HUDSON PARKWAY
Second Line	:	APT 810
City	:	RIVERDALE
State	:	NY
Zip	:	10471-3811
Country	:	US
Telephone Number	:	718-549-2605
Fax Number	:	718-884-1338

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	07/30/2007

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