Healthcare Provider Details

I. General information

NPI: 1114384724
Provider Name (Legal Business Name): DAVID BERK ASW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2016
Last Update Date: 04/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7806 UPLANDS WAY
CITRUS HEIGHTS CA
95610-7567
US

IV. Provider business mailing address

8851 SALMON FALLS DR UNIT F
SACRAMENTO CA
95826-1947
US

V. Phone/Fax

Practice location:
  • Phone: 916-725-0714
  • Fax:
Mailing address:
  • Phone: 916-969-0877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number70654
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: