Provider Demographics
NPI:1154531549
Name:BERG, DAVID ALAN (LMSW)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ALAN
Last Name:BERG
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5511 G.5 RD
Mailing Address - Street 2:
Mailing Address - City:ESCANABA
Mailing Address - State:MI
Mailing Address - Zip Code:49829-9743
Mailing Address - Country:US
Mailing Address - Phone:906-399-4463
Mailing Address - Fax:906-786-5859
Practice Address - Street 1:N15019 HANNAHVILLE B1 RD
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:MI
Practice Address - Zip Code:49896
Practice Address - Country:US
Practice Address - Phone:906-466-2782
Practice Address - Fax:906-466-7454
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010799741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical