Active NPI
Stetson Lea Berg, LSAA
- Case Manager/Care Coordinator
- Albuquerque, NM
National Provider Identifier
1922401165
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Case Manager/Care Coordinator
- Practice address
- 2600 Marble Ave NE
Albuquerque, NM 87106-2058 - Phone
- (505) 272-2479
- Fax
- (505) 272-9843
- NPI assigned
- Oct 2, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 0164591 | NM | |
| Case Manager/Care Coordinator | 171M00000X | NM | Primary |
Addresses
Primary practice location
2600 Marble Ave NE
Albuquerque, NM 87106-2058
Mailing address
2600 Marble Ave NE
Albuquerque, NM 87106-2058
Phone (505) 272-2479
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0164591 | NM | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1412208000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1412640000000",
"number": "1922401165",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2600 MARBLE AVE NE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871062058",
"telephone_number": "505-272-2479",
"fax_number": "505-272-9843"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2600 MARBLE AVE NE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871062058",
"telephone_number": "505-272-2479",
"fax_number": "505-272-9843"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERG",
"first_name": "STETSON",
"middle_name": "LEA",
"credential": "LSAA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-10-02",
"last_updated": "2014-10-07",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "NM",
"license": "0164591",
"primary": false
},
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": "NM",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.