Provider Demographics
NPI:1992177505
Name:DORITA S. BERGER
Entity Type:Organization
Organization Name:DORITA S. BERGER
Other - Org Name:THE MUSIC THERAPY CLINIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:BOARD CERTIFIED MUSIC THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DORITA
Authorized Official - Middle Name:S
Authorized Official - Last Name:BERGER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MT-BC, LCAT
Authorized Official - Phone:203-984-7664
Mailing Address - Street 1:1657 SNOWMASS WAY
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-4514
Mailing Address - Country:US
Mailing Address - Phone:203-984-7664
Mailing Address - Fax:
Practice Address - Street 1:1657 SNOWMASS WAY
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-4514
Practice Address - Country:US
Practice Address - Phone:203-984-7664
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-22
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization