Provider Demographics
NPI:1225547144
Name:BERKSHIRE LIFE COACHING AND COUNSELING
Entity Type:Organization
Organization Name:BERKSHIRE LIFE COACHING AND COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:FISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:413-728-2088
Mailing Address - Street 1:627 LENOX RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:MA
Mailing Address - Zip Code:01254-5260
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:627 LENOX RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:MA
Practice Address - Zip Code:01254-5260
Practice Address - Country:US
Practice Address - Phone:413-728-2088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-22
Last Update Date:2017-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1548251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1194138230Medicaid