Healthcare Provider Details

I. General information

NPI: 1215040704
Provider Name (Legal Business Name): XANA S. BERTINO LCSW, BCD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 01/28/2021
Certification Date: 01/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 N FRANKLIN ST STE 112-3
DOYLESTOWN PA
18901-3536
US

IV. Provider business mailing address

16 N FRANKLIN ST STE 112-3
DOYLESTOWN PA
18901-3536
US

V. Phone/Fax

Practice location:
  • Phone: 267-935-9262
  • Fax:
Mailing address:
  • Phone: 267-935-9262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW014236
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: