Healthcare Provider Details
I. General information
NPI: 1700891413
Provider Name (Legal Business Name): BERKO PSYCHOLOGICAL ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 07/30/2006
Last Update Date: 03/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
6575 ASHTON LN
SOLON OH
44139-3213
US
IV. Provider business mailing address
PO BOX 391057
SOLON OH
44139-8057
US
V. Phone/Fax
- Phone: 440-668-8564
- Fax: 877-844-4869
- Phone: 440-668-8564
- Fax: 877-844-4869
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 104100000X |
| Taxonomy | Social Worker |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 103T00000X |
| Taxonomy | Psychologist |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
ERIC
H
BERKO
Title or Position: OWNER
Credential: PHD
Phone: 440-668-8564