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NPI Code Detail

MEDICARE: MIROSLAWA BERKVAM LCSW

MEDICARE: MIROSLAWA BERKVAM 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
11041C0700XClinical Social Worker34002078AIN

General Provider Information

NPI Number : 1710950761
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIROSLAWA BERKVAM LCSW
Provider Business Mailing Address
First Line : 601 W 2ND ST
Second Line :
City : BLOOMINGTON
State : IN
Zip : 47403-2317
Country : US
Telephone Number : 812-353-9568
Fax Number : 812-353-9318
Provider Business Practice Location Address
First Line : 601 W 2ND ST
Second Line :
City : BLOOMINGTON
State : IN
Zip : 47403-2317
Country : US
Telephone Number : 812-353-9568
Fax Number : 812-353-9318
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/09/2006
Last Update Date : 07/08/2007

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Directions to “ MIROSLAWA BERKVAM LCSW” Practice Location

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