Provider Demographics
NPI:1235263880
Name:BERKOWITZ, JESSICA (LICSW)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:
Last Name:BERKOWITZ
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:LYNNE
Other - Last Name:BERKOWITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:97 LOWELL RD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-1733
Mailing Address - Country:US
Mailing Address - Phone:781-860-2534
Mailing Address - Fax:
Practice Address - Street 1:97 LOWELL RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-1733
Practice Address - Country:US
Practice Address - Phone:781-860-2534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10247091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP10320OtherBCBS
MA226825OtherTRICARE
MAP10320OtherBCBS