Provider Demographics
NPI:1952286304
Name:BERG, ABE MICHAEL
Entity type:Individual
Prefix:
First Name:ABE
Middle Name:MICHAEL
Last Name:BERG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1565 VIENNA DR
Mailing Address - Street 2:
Mailing Address - City:FERDINAND
Mailing Address - State:IN
Mailing Address - Zip Code:47532-9184
Mailing Address - Country:US
Mailing Address - Phone:812-631-1984
Mailing Address - Fax:812-631-1984
Practice Address - Street 1:1565 VIENNA DR
Practice Address - Street 2:
Practice Address - City:FERDINAND
Practice Address - State:IN
Practice Address - Zip Code:47532-9184
Practice Address - Country:US
Practice Address - Phone:812-631-1984
Practice Address - Fax:812-631-1984
Is Sole Proprietor?:No
Enumeration Date:2025-08-06
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician