Provider Demographics
NPI:1114567492
Name:BERL, ALLISON LEE (MA)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:LEE
Last Name:BERL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9237 N NEW YORK AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97203-2264
Mailing Address - Country:US
Mailing Address - Phone:858-353-7736
Mailing Address - Fax:
Practice Address - Street 1:7319 N JOHN AVE STE 101
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97203-4890
Practice Address - Country:US
Practice Address - Phone:971-202-0711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-14
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health