Provider Demographics
NPI:1871968404
Name:BERGER, JOSEPH (LICSW)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:BERGER
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:354 MANHATTAN DR
Mailing Address - Street 2:UNIT 1
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-4281
Mailing Address - Country:US
Mailing Address - Phone:914-456-6609
Mailing Address - Fax:
Practice Address - Street 1:2 CHURCH ST STE 4A
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-4457
Practice Address - Country:US
Practice Address - Phone:802-391-9080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-08
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089-01107161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1026237Medicaid