Healthcare Provider Details

I. General information

NPI: 1861039737
Provider Name (Legal Business Name): NATALIE BERKMAN, LCSW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2019
Last Update Date: 12/10/2019
Certification Date: 12/10/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 E 11TH AVE
EUGENE OR
97401-3295
US

IV. Provider business mailing address

280 E 11TH AVE
EUGENE OR
97401-3295
US

V. Phone/Fax

Practice location:
  • Phone: 541-632-6627
  • Fax: 541-485-0444
Mailing address:
  • Phone: 541-632-6627
  • Fax: 541-485-0444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier500754561
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name: NATALIE BERKMAN
Title or Position: MANAGER
Credential: LCSW
Phone: 541-632-6627