Provider Demographics
NPI:1083784888
Name:BERENSON, JUDITH (MSW)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:BERENSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 TOWER PL
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10552-1024
Mailing Address - Country:US
Mailing Address - Phone:914-699-0892
Mailing Address - Fax:914-699-4982
Practice Address - Street 1:18 TOWER PL
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10552-1024
Practice Address - Country:US
Practice Address - Phone:914-699-0892
Practice Address - Fax:914-699-4982
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR013029-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical