Provider Demographics
NPI:1619231420
Name:BERG, DAWN (BCABA)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:BERG
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6867 SOUTHPOINT DR N STE 106
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-8005
Mailing Address - Country:US
Mailing Address - Phone:904-619-6071
Mailing Address - Fax:904-212-0309
Practice Address - Street 1:6867 SOUTHPOINT DR N STE 106
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-8005
Practice Address - Country:US
Practice Address - Phone:904-619-6071
Practice Address - Fax:904-212-0309
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-26
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst