Provider Demographics
NPI:1013644368
Name:BERG, NATALIE SUSAN
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:SUSAN
Last Name:BERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 448
Mailing Address - Street 2:
Mailing Address - City:POINT ARENA
Mailing Address - State:CA
Mailing Address - Zip Code:95468-0448
Mailing Address - Country:US
Mailing Address - Phone:707-884-4005
Mailing Address - Fax:707-884-4625
Practice Address - Street 1:46900 OCEAN DRIVE
Practice Address - Street 2:
Practice Address - City:GUALALA
Practice Address - State:CA
Practice Address - Zip Code:95445-9544
Practice Address - Country:US
Practice Address - Phone:707-884-4005
Practice Address - Fax:707-884-4625
Is Sole Proprietor?:No
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1092611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical