Brenda R Berg, LCSW
Individual provider Active NPI Clinical Social Worker · Russiaville, IN
NPI 1124014451 · NPPES record last updated May 28, 2008
Key facts
- NPI
- 1124014451
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 34004853A (IN)
- Practice address
- 5282 W 250 S
Russiaville, IN 46979-9412 - Phone
- (765) 883-7873
- Fax
- (765) 883-7714
- NPI assigned
- Sep 22, 2005
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34004853A | IN | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rachelle Steiner, M.D. | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | IN | ||
| Clinical Social Worker | 1041C0700X | 34004853A | IN | Yes |
| Marriage & Family Therapist | 106H00000X | IN |
Addresses
Primary practice location
5282 W 250 S
Russiaville, IN 46979-9412
Mailing address
5282 W 250 S
Russiaville, IN 46979-9412
Phone (765) 883-7873
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000390310 | Other | IN | ANTHEM |
Other providers in Russiaville, IN
- American Health Network of Indiana, LLC
- Michael Joseph Behna
- Board of Trustees of Howard Community Hospital
- James Cole
- Julie Harless Dorneman
- Michael Steven Dunkle
- Kristen L Fox
All providers in Russiaville, IN · Clinical Social Worker in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 28, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.