Provider Demographics
NPI:1811494172
Name:BERGER, KEITH
Entity type:Individual
Prefix:MR
First Name:KEITH
Middle Name:
Last Name:BERGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1446 N ROOK WAY
Mailing Address - Street 2:
Mailing Address - City:STAR
Mailing Address - State:ID
Mailing Address - Zip Code:83669-6306
Mailing Address - Country:US
Mailing Address - Phone:661-965-8097
Mailing Address - Fax:
Practice Address - Street 1:4900 CALIFORNIA AVE STE 100A
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-7027
Practice Address - Country:US
Practice Address - Phone:661-843-1930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-12
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst