Provider Demographics
NPI:1609948629
Name:BERGER, REGULA (PHD)
Entity Type:Individual
Prefix:
First Name:REGULA
Middle Name:
Last Name:BERGER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 GRANBY RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH HADLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01075-2968
Mailing Address - Country:US
Mailing Address - Phone:413-532-6062
Mailing Address - Fax:
Practice Address - Street 1:47 PALOMBA DR
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-3868
Practice Address - Country:US
Practice Address - Phone:860-253-5020
Practice Address - Fax:860-253-5030
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
001161106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health