Provider Demographics
NPI:1083807259
Name:BERGER, BENJAMIN R (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:R
Last Name:BERGER
Suffix:
Gender:M
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:BEN
Other - Middle Name:
Other - Last Name:BERGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, LMHC
Mailing Address - Street 1:PO BOX 3835
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-3835
Mailing Address - Country:US
Mailing Address - Phone:206-548-3114
Mailing Address - Fax:206-762-6355
Practice Address - Street 1:3000 CALIFORNIA AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-3302
Practice Address - Country:US
Practice Address - Phone:206-658-8048
Practice Address - Fax:206-658-8063
Is Sole Proprietor?:No
Enumeration Date:2007-08-21
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60695838101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health