Provider Demographics
NPI:1194911081
Name:BERG, INA R
Entity type:Individual
Prefix:MS
First Name:INA
Middle Name:R
Last Name:BERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 W MARKET ST STE 205
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12538-1303
Mailing Address - Country:US
Mailing Address - Phone:845-750-2520
Mailing Address - Fax:877-224-9708
Practice Address - Street 1:1 W MARKET ST STE 205
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:12538-1303
Practice Address - Country:US
Practice Address - Phone:845-750-2520
Practice Address - Fax:877-224-9708
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR032848104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker