Healthcare Provider Details

I. General information

NPI: 1780872473
Provider Name (Legal Business Name): MICHAL BERKSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 06/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3018 JAVIER RD
FAIRFAX VA
22031-4609
US

IV. Provider business mailing address

3018 JAVIER RD
FAIRFAX VA
22031-4609
US

V. Phone/Fax

Practice location:
  • Phone: 703-204-9100
  • Fax: 703-204-9590
Mailing address:
  • Phone: 703-204-9100
  • Fax: 703-204-9590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC50078840
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW 22190
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: