Provider Demographics
NPI:1871825075
Name:PAUL S.D. BERG, PH.D. & ASSOCIATES
Entity type:Organization
Organization Name:PAUL S.D. BERG, PH.D. & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:S D
Authorized Official - Last Name:BERG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:510-893-3413
Mailing Address - Street 1:389 30TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3402
Mailing Address - Country:US
Mailing Address - Phone:510-893-3413
Mailing Address - Fax:
Practice Address - Street 1:389 30TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3402
Practice Address - Country:US
Practice Address - Phone:510-893-3413
Practice Address - Fax:510-893-3435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-12
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY2811103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PL28110Medicare PIN