Provider Demographics
NPI:1154859619
Name:BERKOVITZ, BRITTANY ANN (MED, LPC)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:ANN
Last Name:BERKOVITZ
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 W MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-9556
Mailing Address - Country:US
Mailing Address - Phone:800-222-8590
Mailing Address - Fax:
Practice Address - Street 1:1511 W MAIN AVE
Practice Address - Street 2:
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-9556
Practice Address - Country:US
Practice Address - Phone:800-222-8590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-30
Last Update Date:2017-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6500-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional