Provider Demographics
NPI:1578335709
Name:BERGER, AMANDA JOY (PMNHP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:JOY
Last Name:BERGER
Suffix:
Gender:F
Credentials:PMNHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7711 ALASTOR CT
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-8157
Mailing Address - Country:US
Mailing Address - Phone:732-887-9344
Mailing Address - Fax:
Practice Address - Street 1:11560 CROSSROADS CIR STE 102
Practice Address - Street 2:
Practice Address - City:MIDDLE RIVER
Practice Address - State:MD
Practice Address - Zip Code:21220-2885
Practice Address - Country:US
Practice Address - Phone:410-508-0722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR174967363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health