Basic Information
| Provider Information | |||||||||
| NPI: | 1578580015 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BERKOVITZ | ||||||||
| FirstName: | DAHLIA | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHD, LMSW, LMFT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ROSEN | ||||||||
| OtherFirstName: | DAHLIA | ||||||||
| OtherMiddleName: | B | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | PHD,LMSW,LMFT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 42450 TWELVE MILE RD. | ||||||||
| Address2: | SUITE #315 | ||||||||
| City: | NOVI | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483773011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2485134100 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 42450 TWELVE MILE RD. | ||||||||
| Address2: | SUITE #315 | ||||||||
| City: | NOVI | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483773013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2485134100 | ||||||||
| FaxNumber: | 2485134105 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 12/11/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 6801072470 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | 106H00000X | 4101006185 | MI | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.