Healthcare Provider Details

I. General information

NPI: 1679885024
Provider Name (Legal Business Name): JENNIFER IRENE BERBERICH LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER IRENE SITARIK

II. Dates (important events)

Enumeration Date: 07/13/2010
Last Update Date: 06/21/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 F MOUNTAIN RD.
PASADENA MD
21122
US

IV. Provider business mailing address

3100 F MOUNTAIN RD.
PASADENA MD
21122
US

V. Phone/Fax

Practice location:
  • Phone: 410-841-9647
  • Fax: 614-355-8361
Mailing address:
  • Phone: 410-841-9647
  • Fax: 614-355-8361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number21746
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: