Provider Demographics
NPI:1114384724
Name:BERK, DAVID (ASW)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:BERK
Suffix:
Gender:M
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8851 SALMON FALLS DR UNIT F
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826-1947
Mailing Address - Country:US
Mailing Address - Phone:916-969-0877
Mailing Address - Fax:
Practice Address - Street 1:7806 UPLANDS WAY
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-7567
Practice Address - Country:US
Practice Address - Phone:916-725-0714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-27
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CA70654104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist