Provider Demographics
NPI:1811048556
Name:BERG, RICHARD A (LICSW)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:A
Last Name:BERG
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 11TH ST SW
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56345-1917
Mailing Address - Country:US
Mailing Address - Phone:320-632-2423
Mailing Address - Fax:
Practice Address - Street 1:1109 11TH ST SW
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:MN
Practice Address - Zip Code:56345-1917
Practice Address - Country:US
Practice Address - Phone:320-632-2423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN62161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical