Provider Demographics
NPI:1497002646
Name:BERGE, ERICA ROSE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:ROSE
Last Name:BERGE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6551 S REVERE PKWY STE 160
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80111-6469
Mailing Address - Country:US
Mailing Address - Phone:720-335-7444
Mailing Address - Fax:720-306-5502
Practice Address - Street 1:6551 S REVERE PKWY STE 160
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80111-6469
Practice Address - Country:US
Practice Address - Phone:720-335-7444
Practice Address - Fax:720-306-5502
Is Sole Proprietor?:No
Enumeration Date:2012-08-07
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
COCSW.099262111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCSW.09926211OtherLCSW