Active NPI
Lauren A. Berg, MA, LPA
- Psychologist
- Portland, OR
National Provider Identifier
1295881019
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 5054
- Practice address
- 1308 NW 20TH Ave
Portland, OR 97209-1607 - Phone
- (503) 358-4122
- Fax
- (503) 977-2615
- NPI assigned
- Jan 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 5054 | OR | Primary |
Addresses
Primary practice location
1308 NW 20TH Ave
Portland, OR 97209-1607
Mailing address
1308 NW 20TH Ave
Portland, OR 97209-1607
Phone (503) 358-4122
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CAQH# 11653362 | Other | CAQH |
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)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5054 | OR | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169769600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1295881019",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1308 NW 20TH AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972091607",
"telephone_number": "503-358-4122",
"fax_number": "503-977-2615"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1308 NW 20TH AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972091607",
"telephone_number": "503-358-4122",
"fax_number": "503-977-2615"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERG",
"first_name": "LAUREN",
"middle_name": "A.",
"credential": "MA, LPA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "OR",
"license": "5054",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAQH",
"identifier": "CAQH# 11653362",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
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.