Provider Demographics
NPI:1215541354
Name:BERG, DANIELLE (MFA, MHC-LP)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:BERG
Suffix:
Gender:F
Credentials:MFA, MHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 E 17TH ST APT 3B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-3117
Mailing Address - Country:US
Mailing Address - Phone:516-639-9132
Mailing Address - Fax:
Practice Address - Street 1:148 WILSON AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-8042
Practice Address - Country:US
Practice Address - Phone:929-399-3691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-05
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health