Provider Demographics
NPI:1417490426
Name:BERGER, KARLO (LCMT)
Entity Type:Individual
Prefix:MR
First Name:KARLO
Middle Name:
Last Name:BERGER
Suffix:
Gender:M
Credentials:LCMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 4TH ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-3754
Mailing Address - Country:US
Mailing Address - Phone:401-477-2845
Mailing Address - Fax:
Practice Address - Street 1:1 RICHMOND SQ
Practice Address - Street 2:SUITE 120K
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-5139
Practice Address - Country:US
Practice Address - Phone:401-477-2845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-22
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMT02256172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker