Provider Demographics
NPI:1225033525
Name:BERK, OTTO MICHAEL (LCSW)
Entity Type:Individual
Prefix:MR
First Name:OTTO
Middle Name:MICHAEL
Last Name:BERK
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6762 BURNS ST
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-3537
Mailing Address - Country:US
Mailing Address - Phone:718-544-5522
Mailing Address - Fax:718-544-2345
Practice Address - Street 1:6762 BURNS ST
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-3537
Practice Address - Country:US
Practice Address - Phone:718-544-5522
Practice Address - Fax:718-544-2345
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR-0420311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY182780POtherHIP NY STATE
NY2445244OtherUNITED HEALTH CARE
NY02480211Medicaid
NY2826599000OtherAMERIHEALTH MULTIPLAN
NY558471000OtherMAGELLAN
NY1050730OtherBEACON HEALTH
NY518370OtherNYSHIP EMPIRE PLAN
NYN797C1OtherBCBS
NY10208395OtherAMERIGROUP
NY518370OtherVALUE OPTIONS
NY7527622OtherAETNA
NY248062964OtherUNITED BEHAVIORAL HEALTH
NY307450OtherHEALTHNET MHN
NYP3462946OtherOXFORD
NY518370OtherNYSHIP EMPIRE PLAN
NY518370OtherVALUE OPTIONS