Provider Demographics
NPI:1043656424
Name:BERGER, LAURA PATRICIA (MA, LADC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:PATRICIA
Last Name:BERGER
Suffix:
Gender:F
Credentials:MA, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4747 CAUGHLIN PKWY
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89519-0906
Mailing Address - Country:US
Mailing Address - Phone:775-224-4686
Mailing Address - Fax:775-787-1458
Practice Address - Street 1:4747 CAUGHLIN PKWY
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89519-0906
Practice Address - Country:US
Practice Address - Phone:775-224-4686
Practice Address - Fax:775-787-1458
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-13
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01084-L101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)