Provider Demographics
NPI:1043855430
Name:BERGER, BRITTANY LAUREN (RD)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:LAUREN
Last Name:BERGER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3610 MYSTIC VALLEY PKWY APT N1411
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-5753
Mailing Address - Country:US
Mailing Address - Phone:914-497-6939
Mailing Address - Fax:
Practice Address - Street 1:3610 MYSTIC VALLEY PKWY APT N1411
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-5753
Practice Address - Country:US
Practice Address - Phone:914-497-6939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-09
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5237133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty