Provider Demographics
NPI:1487881272
Name:BERGER, JACQUELYN ROSALYN (PHD)
Entity type:Individual
Prefix:DR
First Name:JACQUELYN
Middle Name:ROSALYN
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 1:2180 PARK AVE N
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-2359
Mailing Address - Country:US
Mailing Address - Phone:407-647-0307
Mailing Address - Fax:
Practice Address - Street 1:2180 PARK AVE N
Practice Address - Street 2:SUITE 300
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-2359
Practice Address - Country:US
Practice Address - Phone:407-647-0307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-18
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT105106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist