Healthcare Provider Details

I. General information

NPI: 1184792541
Provider Name (Legal Business Name): PAMELA MOSER BERKWITZ LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13100 WAYZATA BLVD SUITE 400
MINNETONKA MN
55305-1802
US

IV. Provider business mailing address

2425 FRANCE AVE S
MINNEAPOLIS MN
55416-3820
US

V. Phone/Fax

Practice location:
  • Phone: 952-546-0616
  • Fax: 952-573-1778
Mailing address:
  • Phone: 952-920-3364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10861
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: