Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY 4968 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY 4968 | CA |
NPI | 1003905621 |
---|---|
Provider Name | Dr. Pamela I Berg |
First Address | Huntington Beach, CA 92647-3806 |
Second Address | Huntington Beach, CA 92647-3806 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 08/07/2007 |