MEDICARE: MS. DEBORAH BOND BERK LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	102238	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	254992	OTHER	MA	MAGELLAN BEHAVIORAL
2	P02550	OTHER	MA	BLUE SHIELD OF MASS

General Provider Information

NPI Number	:	1457442048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEBORAH BOND BERK LICSW

Provider Business Mailing Address
First Line	:	236 GLEN RD
Second Line	:
City	:	WESTON
State	:	MA
Zip	:	02493-2237
Country	:	US
Telephone Number	:	781-431-7792
Fax Number	:	781-431-9622

Provider Business Practice Location Address
First Line	:	236 GLEN RD
Second Line	:
City	:	WESTON
State	:	MA
Zip	:	02493-2237
Country	:	US
Telephone Number	:	781-431-7792
Fax Number	:	781-431-9622

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	07/08/2007

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