Provider Demographics
NPI:1477934941
Name:BERG, PATRICK
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:BERG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 NUUANU AVE
Mailing Address - Street 2:APT J
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-3282
Mailing Address - Country:US
Mailing Address - Phone:330-631-2931
Mailing Address - Fax:
Practice Address - Street 1:1616 NUUANU AVE
Practice Address - Street 2:APT J
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-3282
Practice Address - Country:US
Practice Address - Phone:330-631-2931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-10
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI9788283OtherKAISER PERMANENTE