Provider Demographics
NPI:1275515975
Name:BERLAD, TINA BETH (MS CCC SLP)
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:BETH
Last Name:BERLAD
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:MS
Other - First Name:TINA
Other - Middle Name:B
Other - Last Name:BERLAND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7 DANIEL RD
Mailing Address - Street 2:
Mailing Address - City:HOPKINTON
Mailing Address - State:MA
Mailing Address - Zip Code:01748-2434
Mailing Address - Country:US
Mailing Address - Phone:508-435-1948
Mailing Address - Fax:
Practice Address - Street 1:215 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:MA
Practice Address - Zip Code:02766
Practice Address - Country:US
Practice Address - Phone:508-285-0140
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA99235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist