Basic Information
| Provider Information | |||||||||
| NPI: | 1831151224 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BERGER | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | JOHN | ||||||||
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| Credential: | PSY.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3102 E. HIGHLAND AVENUE | ||||||||
| Address2: | MEDICAL STAFF OFFICE | ||||||||
| City: | PATTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92369 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9094257679 | ||||||||
| FaxNumber: | 9094256635 | ||||||||
| Practice Location | |||||||||
| Address1: | 3102 E. HIGHLAND AVENUE | ||||||||
| Address2: | MEDICAL STAFF OFFICE | ||||||||
| City: | PATTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92369 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9094257679 | ||||||||
| FaxNumber: | 9094256635 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2006 | ||||||||
| LastUpdateDate: | 08/26/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | PS008599L | PA | Y | Behavioral Health & Social Service Providers | Psychologist | 103TB0200X | PS008599L | PA | N | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral |
ID Information
| ID | Type | State | Issuer | Description | 809366 | 01 | PA | FIRST PRIORITY HEALTH | OTHER | 0017638180002 | 05 | PA | MEDICAID | 481729 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | R34049 | 01 | PA | HEALTHAMERICA | OTHER | 467613 | 01 | PA | VALUE OPTIONS | OTHER |