MEDICARE: MRS. DELFINA BERRIO LCSW

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	44SC00085500	NJ

General Provider Information

NPI Number	:	1588711980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DELFINA BERRIO LCSW

Provider Business Mailing Address
First Line	:	165 VALLEY VIEW RD
Second Line	:
City	:	HILLSIDE
State	:	NJ
Zip	:	07205-2515
Country	:	US
Telephone Number	:	908-247-6068
Fax Number	:	201-610-9466

Provider Business Practice Location Address
First Line	:	615 PAVONIA AVE
Second Line	:	SUITE 1
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306-2923
Country	:	US
Telephone Number	:	201-610-9466
Fax Number	:	201-610-0801

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

Provider Enumeration Date	:	01/05/2007
Last Update Date	:	07/08/2007

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