Basic Information
| Provider Information | |||||||||
| NPI: | 1376122671 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BERKOWICH | ||||||||
| FirstName: | KRISTEN | ||||||||
| MiddleName: | |||||||||
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| Credential: | LGSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 210 MEADOW LN | ||||||||
| Address2: | |||||||||
| City: | QUARRYVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 175669339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4433500825 | ||||||||
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| Practice Location | |||||||||
| Address1: | 111 RYAN DR | ||||||||
| Address2: | |||||||||
| City: | RISING SUN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 219111841 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106429172 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2021 | ||||||||
| LastUpdateDate: | 04/05/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 24248 | MD | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.