Basic Information
| Provider Information | |||||||||
| NPI: | 1457585036 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BERGER | ||||||||
| FirstName: | STUART | ||||||||
| MiddleName: | MARK | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | R.N., M.S.N., C.N.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 802 BREWSTER AVE | ||||||||
| Address2: | |||||||||
| City: | REDWOOD CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940631510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6503634111 | ||||||||
| FaxNumber: | 6503646927 | ||||||||
| Practice Location | |||||||||
| Address1: | 802 BREWSTER AVE | ||||||||
| Address2: | |||||||||
| City: | REDWOOD CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940631510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6503634111 | ||||||||
| FaxNumber: | 6503646927 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2009 | ||||||||
| LastUpdateDate: | 05/11/2009 | ||||||||
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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 | 163WP0809X | 650100 | CA | Y | Nursing Service Providers | Registered Nurse | Psych/Mental Health, Adult |
No ID Information.