Provider Demographics
NPI:1790800316
Name:BERGER, JEANNE B (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEANNE
Middle Name:B
Last Name:BERGER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:JEANNE
Other - Middle Name:B
Other - Last Name:BUYCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 4127
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24015-0127
Mailing Address - Country:US
Mailing Address - Phone:540-981-9394
Mailing Address - Fax:540-344-7154
Practice Address - Street 1:1315 2ND ST SW
Practice Address - Street 2:SUITE 201
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-4944
Practice Address - Country:US
Practice Address - Phone:540-915-1508
Practice Address - Fax:540-344-5941
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003326103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3980710Medicare ID - Type Unspecified