Provider Demographics
NPI:1184377384
Name:FORBES BERG, ANTONIA (PHD)
Entity type:Individual
Prefix:DR
First Name:ANTONIA
Middle Name:
Last Name:FORBES BERG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:ANTONIA
Other - Middle Name:
Other - Last Name:FORBES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1590 E 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97403-1967
Mailing Address - Country:US
Mailing Address - Phone:541-346-2716
Mailing Address - Fax:
Practice Address - Street 1:1590 E 13TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97403-1967
Practice Address - Country:US
Practice Address - Phone:541-346-2716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-28
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling