Provider Demographics
NPI:1003438698
Name:BERKEY, SHANNON (LCSW)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:BERKEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:865 EISENHOWER BLVD
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-3318
Mailing Address - Country:US
Mailing Address - Phone:814-266-8840
Mailing Address - Fax:814-266-4922
Practice Address - Street 1:865 EISENHOWER BLVD
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-3318
Practice Address - Country:US
Practice Address - Phone:814-266-8840
Practice Address - Fax:814-266-4922
Is Sole Proprietor?:No
Enumeration Date:2020-05-18
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0237161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical