Provider Demographics
NPI:1053185835
Name:BERG PSYCHOTHERAPY ASSOCIATES PLLC
Entity type:Organization
Organization Name:BERG PSYCHOTHERAPY ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LIMITED LICENSE PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:LETICIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BERG
Authorized Official - Suffix:
Authorized Official - Credentials:LLP
Authorized Official - Phone:248-436-4940
Mailing Address - Street 1:28475 GREENFIELD RD STE 113-1312
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-3034
Mailing Address - Country:US
Mailing Address - Phone:248-436-4940
Mailing Address - Fax:
Practice Address - Street 1:25217 PARKWOOD DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON WOODS
Practice Address - State:MI
Practice Address - Zip Code:48070-1739
Practice Address - Country:US
Practice Address - Phone:248-436-4940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty