Provider Demographics
NPI:1649460460
Name:BERGER, JODI L (MFTI)
Entity type:Individual
Prefix:MRS
First Name:JODI
Middle Name:L
Last Name:BERGER
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18345 CARLWYN DR
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-2027
Mailing Address - Country:US
Mailing Address - Phone:510-432-3625
Mailing Address - Fax:
Practice Address - Street 1:18345 CARLWYN DR
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-2027
Practice Address - Country:US
Practice Address - Phone:510-432-3625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44880106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA733324OtherCAL. DRIVERS LIC.