Provider Demographics
NPI:1568669166
Name:BERG, RICHARD LEWIS (LMFT)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:LEWIS
Last Name:BERG
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4853 TILDEN AVE
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-1717
Mailing Address - Country:US
Mailing Address - Phone:818-645-8106
Mailing Address - Fax:
Practice Address - Street 1:22231 MULHOLLAND HWY #106
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-5178
Practice Address - Country:US
Practice Address - Phone:818-222-9300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC44229106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist