Provider Demographics
NPI:1063697001
Name:BERG, JANYCE RUTHANN (PMHNP-BC)
Entity type:Individual
Prefix:MS
First Name:JANYCE
Middle Name:RUTHANN
Last Name:BERG
Suffix:
Gender:
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3133 REDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-2510
Mailing Address - Country:US
Mailing Address - Phone:303-913-3685
Mailing Address - Fax:303-913-3685
Practice Address - Street 1:3133 REDWOOD DR
Practice Address - Street 2:
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003-2510
Practice Address - Country:US
Practice Address - Phone:303-913-3685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-09
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA950135502084P0800X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
COAPN.0994801-NPOtherCO NURSING BOARD