Provider Demographics
NPI:1225342140
Name:BERGER, DIANE M (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:M
Last Name:BERGER
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18A JOHNSON AVE
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-4818
Mailing Address - Country:US
Mailing Address - Phone:201-742-5298
Mailing Address - Fax:
Practice Address - Street 1:18A JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-4818
Practice Address - Country:US
Practice Address - Phone:201-742-5298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst