Provider Demographics
NPI:1093958209
Name:BERG, LORI RACHEL (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:RACHEL
Last Name:BERG
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MS
Other - First Name:LORI
Other - Middle Name:RACHEL
Other - Last Name:SILVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:3015 29TH ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-2502
Mailing Address - Country:US
Mailing Address - Phone:718-956-2765
Mailing Address - Fax:
Practice Address - Street 1:30-15 29TH ST
Practice Address - Street 2:PS 234
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102
Practice Address - Country:US
Practice Address - Phone:516-314-5999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-17
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011-068-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist