Active NPI
Nicole Theresa Berg VI, LICSW
- Counselor
- Destin, FL
National Provider Identifier
1982321865
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- ISW17459
- Practice address
- 301 Corinthian PL
Destin, FL 32541-5338 - Phone
- (210) 784-0397
- NPI assigned
- Oct 21, 2022
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Counselor | 101Y00000X | |||
| Counselor | 101Y00000X | ISW17459 | FL | Primary |
Addresses
Primary practice location
301 Corinthian PL
Destin, FL 32541-5338
Mailing address
301 Corinthian PL
Destin, FL 32541-5338
Phone (210) 784-0397
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 409907 | Medicaid | FL |
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | remotecomputerdevice | ||
| Other URL | workconnect |
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 |
|---|---|---|---|
| ISW17459 | FL | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1666310400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1666310400000",
"number": "1982321865",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "301 CORINTHIAN PL",
"city": "DESTIN",
"state": "FL",
"postal_code": "325415338",
"telephone_number": "210-784-0397"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "301 CORINTHIAN PL",
"city": "DESTIN",
"state": "FL",
"postal_code": "325415338",
"telephone_number": "210-784-0397"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERG",
"first_name": "NICOLE",
"middle_name": "THERESA",
"name_suffix": "VI",
"credential": "LICSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-10-21",
"last_updated": "2022-10-21",
"certification_date": "2022-10-21",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"primary": false
},
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "FL",
"license": "ISW17459",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "409907",
"state": "FL"
}
],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "remotecomputerdevice",
"affiliation": "N",
"address_1": "301 Corinthian Pl",
"city": "Destin",
"state": "FL",
"country_code": "US",
"postal_code": "325415338",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "workconnect",
"affiliation": "N",
"address_1": "301 Corinthian Pl",
"city": "Destin",
"state": "FL",
"country_code": "US",
"postal_code": "325415338",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Destin, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.