Provider Demographics
NPI:1043417330
Name:SAMUEL BERKOWITZ, PH.D., INC.
Entity Type:Organization
Organization Name:SAMUEL BERKOWITZ, PH.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BERKOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:410-730-5138
Mailing Address - Street 1:5018 DORSEY HALL DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-7855
Mailing Address - Country:US
Mailing Address - Phone:410-730-5138
Mailing Address - Fax:410-997-0603
Practice Address - Street 1:5018 DORSEY HALL DR
Practice Address - Street 2:SUITE 205
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-7855
Practice Address - Country:US
Practice Address - Phone:410-730-5138
Practice Address - Fax:410-997-0603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD461-MD103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD178PMedicare PIN