Basic Information
| Provider Information | |||||||||
| NPI: | 1942723978 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BERKLEY | ||||||||
| FirstName: | BRITTANY | ||||||||
| MiddleName: | NICOLE | ||||||||
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| Credential: | LSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6141 ALBERT AVE # A101 | ||||||||
| Address2: | |||||||||
| City: | NORTH RIDGEVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440391671 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4402584386 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 347 MIDWAY BLVD STE 200 | ||||||||
| Address2: | |||||||||
| City: | ELYRIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440352496 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4403245701 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2017 | ||||||||
| LastUpdateDate: | 07/21/2017 | ||||||||
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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 | 101YM0800X | OH | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.