Healthcare Provider Details

I. General information

NPI: 1386604247
Provider Name (Legal Business Name): ALICE BERKE LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALICE BERKE LICSW

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 11/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 MAIN ST.
WEST STOCKBRIDGE MA
01266
US

IV. Provider business mailing address

PO BOX 204
MONTEREY MD
01245
US

V. Phone/Fax

Practice location:
  • Phone: 413-528-8206
  • Fax: 413-232-0111
Mailing address:
  • Phone: 413-528-8206
  • Fax: 413-232-0111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number110282
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number066278
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: