Provider Demographics
NPI:1689859415
Name:BERGER, SCOTT MICHEAL (LCPC)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:MICHEAL
Last Name:BERGER
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9651 WHITEACRE ROAD
Mailing Address - Street 2:A-4
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-3587
Mailing Address - Country:US
Mailing Address - Phone:410-997-8027
Mailing Address - Fax:
Practice Address - Street 1:9651 WHITEACRE RD
Practice Address - Street 2:A-4
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-3587
Practice Address - Country:US
Practice Address - Phone:410-997-8027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-28
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2378101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional