Provider Demographics
NPI:1780677575
Name:BERGER, BARRY D (PHD)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:D
Last Name:BERGER
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 1:2504 N CONWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78574-2349
Mailing Address - Country:US
Mailing Address - Phone:956-519-9000
Mailing Address - Fax:956-519-7722
Practice Address - Street 1:2504 N CONWAY AVE
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78574-2349
Practice Address - Country:US
Practice Address - Phone:956-519-9000
Practice Address - Fax:956-519-7722
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-4485103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00149YMedicare ID - Type UnspecifiedMEDICARE