Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | ||
N | 102L00000X | Psychologist | ||
N | 103T00000X | Psychologist | ||
N | 103K00000X | Behavior Analyst | ||
N | 1041C0700X | Clinical Social Worker | ||
N | 106E00000X | Assistant Behavior Analyst | ||
N | 106S00000X | Behavior Technician |
NPI | 1174061758 |
---|---|
Provider Name | Dr. Joseph Leon Berg |
First Address | North Miami Beach, FL 33160 |
Second Address | North Miami Beach, FL 33162-3712 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2017 |
Last Update Date | 03/02/2017 |