Provider Demographics
NPI:1063644409
Name:BERKS, DELORIA (LCSW, CASACT)
Entity Type:Individual
Prefix:
First Name:DELORIA
Middle Name:
Last Name:BERKS
Suffix:
Gender:F
Credentials:LCSW, CASACT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 E 11TH ST # 51
Mailing Address - Street 2:SUITE 40
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4602
Mailing Address - Country:US
Mailing Address - Phone:646-494-3134
Mailing Address - Fax:
Practice Address - Street 1:41 E 11TH ST # 51
Practice Address - Street 2:SUITE 40
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4602
Practice Address - Country:US
Practice Address - Phone:646-494-3134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-19
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY23033101YA0400X
NY08449-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)