Provider Demographics
NPI:1770207151
Name:BERGER, NICOLE S (PSYD)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:S
Last Name:BERGER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2722 WOODCOURT RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-2522
Mailing Address - Country:US
Mailing Address - Phone:954-296-1838
Mailing Address - Fax:
Practice Address - Street 1:1190 WINTERSON RD STE 160
Practice Address - Street 2:
Practice Address - City:LINTHICUM
Practice Address - State:MD
Practice Address - Zip Code:21090-2245
Practice Address - Country:US
Practice Address - Phone:410-684-3806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDA0832OtherMARYLAND BOARD OF EXAMINERS OF PSYCHOLOGISTS