Healthcare Provider Details

I. General information

NPI: 1265421259
Provider Name (Legal Business Name): JAMES BERWICK LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 07/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1955 US HIGHWAY 1 S SUITE C-2
ST AUGUSTINE FL
32086-3708
US

IV. Provider business mailing address

1955 US HIGHWAY 1 S SUITE C-2
ST AUGUSTINE FL
32086-3708
US

V. Phone/Fax

Practice location:
  • Phone: 904-209-6022
  • Fax: 904-209-6002
Mailing address:
  • Phone: 904-209-6022
  • Fax: 904-209-6002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW1692
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: