Provider Demographics
NPI:1639167331
Name:BERG, CARL (PHD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:
Last Name:BERG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 DOWNING ST
Mailing Address - Street 2:1-J
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-4734
Mailing Address - Country:US
Mailing Address - Phone:212-229-1954
Mailing Address - Fax:212-686-5330
Practice Address - Street 1:10 DOWNING ST
Practice Address - Street 2:1-J
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-4734
Practice Address - Country:US
Practice Address - Phone:212-229-1954
Practice Address - Fax:212-686-5330
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006203103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV16501Medicare ID - Type UnspecifiedMEDICARE