Provider Demographics
NPI:1891857058
Name:BERG, BRIDGET LYNN
Entity type:Individual
Prefix:MS
First Name:BRIDGET
Middle Name:LYNN
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 1:1018 BANBURY CT
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-4354
Mailing Address - Country:US
Mailing Address - Phone:707-255-5139
Mailing Address - Fax:707-255-5139
Practice Address - Street 1:2101 COURAGE DRIVE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533
Practice Address - Country:US
Practice Address - Phone:707-784-4900
Practice Address - Fax:707-399-4957
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF98165101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health