Provider Demographics
NPI:1215203146
Name:BERKS HYPNOSIS AND COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:BERKS HYPNOSIS AND COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:ARENA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, JD, MBA
Authorized Official - Phone:215-939-8429
Mailing Address - Street 1:148 ROBBY DR
Mailing Address - Street 2:
Mailing Address - City:LEESPORT
Mailing Address - State:PA
Mailing Address - Zip Code:19533-9434
Mailing Address - Country:US
Mailing Address - Phone:610-916-3594
Mailing Address - Fax:610-926-9179
Practice Address - Street 1:5 S CENTRE AVE
Practice Address - Street 2:SUITE A5
Practice Address - City:LEESPORT
Practice Address - State:PA
Practice Address - Zip Code:19533-8653
Practice Address - Country:US
Practice Address - Phone:610-916-3594
Practice Address - Fax:610-926-9179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC005641101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty