Active NPI
Lisa Kathleen Berg-Anderson, M.S.
- Speech-Language Pathologist
- Eastport, NY
National Provider Identifier
1104952837
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 007683-1
- Practice address
- 42 Tuttle Ave
Eastport, NY 11941-1307 - Phone
- (631) 898-0261
- NPI assigned
- Feb 26, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 007683-1 | NY | Primary |
Addresses
Primary practice location
42 Tuttle Ave
Eastport, NY 11941-1307
Mailing address
42 Tuttle Ave
Eastport, NY 11941-1307
Phone (631) 898-0261
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 007683-1 | NY | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172448000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1104952837",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "42 TUTTLE AVE",
"city": "EASTPORT",
"state": "NY",
"postal_code": "119411307",
"telephone_number": "631-898-0261"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "42 TUTTLE AVE",
"city": "EASTPORT",
"state": "NY",
"postal_code": "119411307",
"telephone_number": "631-898-0261"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERG-ANDERSON",
"first_name": "LISA",
"middle_name": "KATHLEEN",
"name_prefix": "Mrs.",
"credential": "M.S.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-02-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NY",
"license": "007683-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eastport, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.