Theodore F. Berg, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

071.009362 Issued in IL

Practice address

53 W Jackson Blvd
Suite 1453
Chicago, IL 60604-3606

Phone

(510) 918-2650

NPI assigned

Jan 1, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1167609600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1481241600000",
    "number": "1487711511",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1313 N RITCHIE CT APT 908",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606102155",
            "telephone_number": "510-918-2650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "53 W JACKSON BLVD",
            "address_2": "SUITE 1453",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606043606",
            "telephone_number": "510-918-2650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERG",
        "first_name": "THEODORE",
        "middle_name": "F.",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-01",
        "last_updated": "2016-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "IL",
            "license": "071.009362",
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "17341",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kim Natasha Berg, M.D.
• Rachel Laurel Berg, LPC
• Sandra Elizabeth Berg, MD
• Sara R Berg, M.D.
• Susan Marie Berg, B.S.,R.PH.
• Raymond Bergan, MD
• Bergen Psychological Services, Inc.
• Anne Bergen
• Carrie Bergen
• Donna C Bergen, MD

• Psychologist in Chicago, IL
• Providers in Chicago, IL by specialty
• Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.