Provider Demographics
NPI:1407669278
Name:VAN DEN BERG, TIMOTHY (RADT)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:VAN DEN BERG
Suffix:
Gender:M
Credentials:RADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24911 OUTLOOK TER
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:CA
Mailing Address - Zip Code:93923-8933
Mailing Address - Country:US
Mailing Address - Phone:408-502-0493
Mailing Address - Fax:
Practice Address - Street 1:20 S SANTA CRUZ AVE STE 319
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95030-6834
Practice Address - Country:US
Practice Address - Phone:408-391-7730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)