Provider Demographics
NPI:1134833619
Name:BERGER, MADELINE (LSW)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:BERGER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 W BRISTOL ST
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-3019
Mailing Address - Country:US
Mailing Address - Phone:574-402-1400
Mailing Address - Fax:
Practice Address - Street 1:401 W BRISTOL ST
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-3019
Practice Address - Country:US
Practice Address - Phone:574-228-5230
Practice Address - Fax:574-228-5232
Is Sole Proprietor?:No
Enumeration Date:2023-01-10
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MI101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)