Bonnie Jan Berg, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

4065 Issued in OR

Practice address

1020 SW Taylor St
Suite 650
Portland, OR 97205-2543

Phone

(503) 224-4654

NPI assigned

Nov 27, 2006

Last updated

May 8, 2008By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 1, 2017 through Jan 1, 2027

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1210204800000",
    "number": "1366518813",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1020 SW TAYLOR ST",
            "address_2": "SUITE 650",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972052543",
            "telephone_number": "503-224-4654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1020 SW TAYLOR ST",
            "address_2": "SUITE 650",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972052543",
            "telephone_number": "503-224-4654"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERG",
        "first_name": "BONNIE",
        "middle_name": "JAN",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-27",
        "last_updated": "2008-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "4065",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Berens
• Kara L Berent, PA-C
• Sarah M Bereznai, NP
• Alik Berg, LMT
• Amanda Berg
• Dane Berg, CADC-II
• Esther Berg, MFT ASSOCIATE
• Jonathan Peter Berg, MASSAGE THERAPIST OR
• Lauren A. Berg, MA, LPA
• Naomi Berg, MA, QMHP

• Clinical Social Worker in Portland, OR
• Providers in Portland, OR by specialty
• Clinical Social Worker in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.