MEDICARE: MS. TRUDY BERKOVITZ MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	105691	MA
2	1041S0200X	School Social Worker	105691	MA

General Provider Information

NPI Number	:	1740427574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TRUDY BERKOVITZ MSW

Provider Business Mailing Address
First Line	:	257 WEST ST
Second Line	:
City	:	NEW SALEM
State	:	MA
Zip	:	01355-9530
Country	:	US
Telephone Number	:	978-544-7558
Fax Number	:	978-544-7558

Provider Business Practice Location Address
First Line	:	257 WEST ST
Second Line	:
City	:	NEW SALEM
State	:	MA
Zip	:	01355-9530
Country	:	US
Telephone Number	:	978-544-7558
Fax Number	:	978-544-7558

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/15/2009
Last Update Date	:	01/15/2009

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