Provider Demographics
NPI:1104152453
Name:BERGER, STEVEN GARY (PHD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:GARY
Last Name:BERGER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4939 LOWER ROSWELL RD
Mailing Address - Street 2:BLDG B - 202
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-4338
Mailing Address - Country:US
Mailing Address - Phone:770-971-3303
Mailing Address - Fax:770-971-3314
Practice Address - Street 1:4939 LOWER ROSWELL RD
Practice Address - Street 2:BLDG B - 202
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-4338
Practice Address - Country:US
Practice Address - Phone:770-971-3303
Practice Address - Fax:770-971-3314
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-21
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002956103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA885524226AMedicaid