Provider Demographics
NPI:1730652116
Name:BERGER, BRIAN L
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:L
Last Name:BERGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 SE CENTRAL PKWY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-3970
Mailing Address - Country:US
Mailing Address - Phone:561-818-8054
Mailing Address - Fax:
Practice Address - Street 1:616 SE CENTRAL PKWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-3970
Practice Address - Country:US
Practice Address - Phone:772-320-5885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-08
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12885101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH12885OtherLICENSED MENTAL HEALTH COUNSELOR