Basic Information
| Provider Information | |||||||||
| NPI: | 1568883676 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BERKOWITZ | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.A.,M.ED. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2257 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011071905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137333488 | ||||||||
| FaxNumber: | 4137317381 | ||||||||
| Practice Location | |||||||||
| Address1: | 2257 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011071905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137333488 | ||||||||
| FaxNumber: | 4137317381 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/17/2013 | ||||||||
| LastUpdateDate: | 12/17/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 275197 | MA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.