Provider Demographics
NPI:1598547630
Name:BERG, BROOKE (BSW)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:BERG
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 E APACHE BLVD # 3067
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-5822
Mailing Address - Country:US
Mailing Address - Phone:401-426-9879
Mailing Address - Fax:
Practice Address - Street 1:1424 S 7TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85007-3902
Practice Address - Country:US
Practice Address - Phone:602-258-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-13
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical