Healthcare Provider Details

I. General information

NPI: 1912958943
Provider Name (Legal Business Name): JOAN W. BERLIN LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 06/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 WASHINGTON ST STE 4
WEST NEWTON MA
02465-2150
US

IV. Provider business mailing address

1121 WASHINGTON ST STE 4
WEST NEWTON MA
02465-2150
US

V. Phone/Fax

Practice location:
  • Phone: 617-620-9202
  • Fax:
Mailing address:
  • Phone: 617-620-9202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number102243
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: