Provider Demographics
NPI:1386793743
Name:BERGER, MARC LEONARD (PSYD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:LEONARD
Last Name:BERGER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:346 WOLCOTT ST
Mailing Address - Street 2:
Mailing Address - City:AUBURNDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02466-1510
Mailing Address - Country:US
Mailing Address - Phone:617-332-0027
Mailing Address - Fax:
Practice Address - Street 1:468 GREAT RD
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-4187
Practice Address - Country:US
Practice Address - Phone:978-635-0509
Practice Address - Fax:978-635-9301
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6684103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical