Provider Demographics
NPI:1265055065
Name:BERGER, ALEXANDER (CASAC)
Entity type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:
Last Name:BERGER
Suffix:
Gender:M
Credentials:CASAC
Other - Prefix:MR
Other - First Name:ALEXANDER
Other - Middle Name:
Other - Last Name:BERGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CASAC
Mailing Address - Street 1:11215 72ND RD STE LL1
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4600
Mailing Address - Country:US
Mailing Address - Phone:718-261-3437
Mailing Address - Fax:718-261-4142
Practice Address - Street 1:11215 72ND RD STE LL1
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4600
Practice Address - Country:US
Practice Address - Phone:718-261-3437
Practice Address - Fax:718-261-4142
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-27
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY12799101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty