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General NPI Number Information
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NPI Number | 1295245140
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Entity Type | Individual
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Provider Name | SHIRLENE V BERKEL MSW, LCSW INTERN
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Gender | Female
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Dates
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Enumeration Date | 10/05/2017
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Last Update Date | 10/05/2017
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Provider Practice Location Address
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Address Line | 5475 WILMINGTON CIR APT 209
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City | LAKELAND
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State | FL
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Zip | 33813-2764
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Country | US
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Telephone | 863-808-6862
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Fax | 863-808-6862
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Provider Business Mailing Address
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Address Line | PO BOX 6482
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City | LAKELAND
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State | FL
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Zip | 33807-6482
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Country | US
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Telephone | 863-500-2480
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | ISW12071
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License Number State | FL
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