Provider Demographics
NPI:1548283286
Name:BERTON, MARGARET W (PHD)
Entity type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:W
Last Name:BERTON
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 1:21 LYNN BATTS
Mailing Address - Street 2:SUITE 11
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78218-3078
Mailing Address - Country:US
Mailing Address - Phone:210-829-1994
Mailing Address - Fax:210-829-8788
Practice Address - Street 1:21 LYNN BATTS LN
Practice Address - Street 2:SUITE 11
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78218-3079
Practice Address - Country:US
Practice Address - Phone:210-829-1994
Practice Address - Fax:210-829-8788
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6416103TS0200X
TX2-5609103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0304594-01Medicaid
TX0304594-01Medicaid