Basic Information
| Provider Information | |||||||||
| NPI: | 1982731832 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BERGER | ||||||||
| FirstName: | MARILYN | ||||||||
| MiddleName: | E. | ||||||||
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| Credential: | CP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3945 W 29TH AVE | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802121433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036912447 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9485 W COLFAX AVE | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802153918 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034325200 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2007 | ||||||||
| LastUpdateDate: | 12/19/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | CO LIC.# 2025 | CO | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.