Provider Demographics
NPI:1043525322
Name:BERKOFF, SARAH
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:BERKOFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:372 CHARLES RIVER RD
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-2738
Mailing Address - Country:US
Mailing Address - Phone:530-304-4449
Mailing Address - Fax:530-304-4449
Practice Address - Street 1:372 CHARLES RIVER RD
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-2738
Practice Address - Country:US
Practice Address - Phone:530-304-4449
Practice Address - Fax:530-304-4449
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-11
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA219405104100000X
MA1194631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110130855AMedicaid