MEDICARE: MS. REBEKAH LOUISE BERKOWITZ MSW

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	SW000054	MO

General Provider Information

NPI Number	:	1538128673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. REBEKAH LOUISE BERKOWITZ MSW

Provider Business Mailing Address
First Line	:	4177 D CRESCENT DR
Second Line	:
City	:	ST LOUIS
State	:	MO
Zip	:	63129-1071
Country	:	US
Telephone Number	:	314-845-0673
Fax Number	:

Provider Business Practice Location Address
First Line	:	4177 D CRESCENT
Second Line	:
City	:	ST LOUIS
State	:	MO
Zip	:	63129-1071
Country	:	US
Telephone Number	:	314-845-0673
Fax Number	:

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

Provider Enumeration Date	:	03/18/2006
Last Update Date	:	07/08/2007

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