Provider Demographics
NPI:1649485525
Name:BERG, DENISE C (LCSW)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:C
Last Name:BERG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 WANTAGH AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-2257
Mailing Address - Country:US
Mailing Address - Phone:516-868-5634
Mailing Address - Fax:516-785-0318
Practice Address - Street 1:1400 WANTAGH AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-2257
Practice Address - Country:US
Practice Address - Phone:516-868-5634
Practice Address - Fax:516-785-0318
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0572741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical