MEDICARE: DR. MARYGRACE BERBERIAN PHD

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	225800000X	Recreation Therapist	000302	NY
2	1041C0700X	Clinical Social Worker	074666	NY

General Provider Information

NPI Number	:	1881460541
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARYGRACE BERBERIAN PHD

Provider Business Mailing Address
First Line	:	520 2ND ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-2630
Country	:	US
Telephone Number	:	917-941-2652
Fax Number	:

Provider Business Practice Location Address
First Line	:	355 5TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-2806
Country	:	US
Telephone Number	:	917-941-2652
Fax Number	:

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

Provider Enumeration Date	:	12/04/2023
Last Update Date	:	12/04/2023

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Directions to “ DR. MARYGRACE BERBERIAN PHD” Practice Location

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