Provider Demographics
NPI:1043319452
Name:BERKS, LINDA (LISW)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:BERKS
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7528 ALPATH RD
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-9625
Mailing Address - Country:US
Mailing Address - Phone:614-855-9923
Mailing Address - Fax:
Practice Address - Street 1:73 MILL ST
Practice Address - Street 2:STE A
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-3080
Practice Address - Country:US
Practice Address - Phone:614-478-9309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-0004720101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health