Provider Demographics
NPI:1457629115
Name:BERGER, MATTHEW ADAM (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:ADAM
Last Name:BERGER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 PARROTT RD
Mailing Address - Street 2:
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994-1025
Mailing Address - Country:US
Mailing Address - Phone:845-753-2720
Mailing Address - Fax:845-753-6636
Practice Address - Street 1:65 PARROTT RD
Practice Address - Street 2:
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-1025
Practice Address - Country:US
Practice Address - Phone:845-753-2720
Practice Address - Fax:845-753-6636
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-09
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014778103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool