Provider Demographics
NPI:1013539006
Name:BERG, AUSTIN (MSW)
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:
Last Name:BERG
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 MIDWAY IS
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33767-2316
Mailing Address - Country:US
Mailing Address - Phone:210-245-0250
Mailing Address - Fax:
Practice Address - Street 1:225 MIDWAY IS
Practice Address - Street 2:
Practice Address - City:CLEARWATER BEACH
Practice Address - State:FL
Practice Address - Zip Code:33767-2316
Practice Address - Country:US
Practice Address - Phone:210-245-0250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-12
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker