Provider Demographics
NPI:1174604904
Name:BERGER, ALLISON H (PHD)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:H
Last Name:BERGER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1696 MASSACHUSETTS AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-1803
Mailing Address - Country:US
Mailing Address - Phone:617-851-4185
Mailing Address - Fax:
Practice Address - Street 1:1696 MASSACHUSETTS AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-1803
Practice Address - Country:US
Practice Address - Phone:617-851-4185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7580103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW05933OtherBCBS
MAW50535Medicare ID - Type Unspecified