Provider Demographics
NPI:1770727117
Name:BERGER, DITZA (PHD)
Entity type:Individual
Prefix:DR
First Name:DITZA
Middle Name:
Last Name:BERGER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:DITZA
Other - Middle Name:D'VORCEH
Other - Last Name:SCHWARTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:445 CENTRAL AVENUE
Mailing Address - Street 2:SUITE 367
Mailing Address - City:CEDARHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11516
Mailing Address - Country:US
Mailing Address - Phone:646-942-4900
Mailing Address - Fax:
Practice Address - Street 1:445 CENTRAL AVENUE
Practice Address - Street 2:SUITE 367
Practice Address - City:CEDARHURST
Practice Address - State:NY
Practice Address - Zip Code:11516
Practice Address - Country:US
Practice Address - Phone:646-942-4900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-29
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015748103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist