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General NPI Number Information
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NPI Number | 1639410442
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Entity Type | Individual
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Provider Name | BERTH BARTOLIN MA, LPC
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Gender | Female
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Dates
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Enumeration Date | 03/05/2013
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Last Update Date | 03/05/2013
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Provider Practice Location Address
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Address Line | 6703 GERMANTOWN AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19119-2109
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Country | US
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Telephone | 215-337-4813
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Fax |
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Provider Business Mailing Address
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Address Line | 4000 GYPSY LN UNIT 504
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City | PHILADELPHIA
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State | PA
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Zip | 19129-5431
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Country | US
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Telephone | 267-968-9263
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PC006070
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License Number State | PA
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