Provider Demographics
NPI:1295833028
Name:BERKOWITCH, GRETCHEN ANN (PMHCNS-BC)
Entity Type:Individual
Prefix:MS
First Name:GRETCHEN
Middle Name:ANN
Last Name:BERKOWITCH
Suffix:
Gender:F
Credentials:PMHCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CUMMINGS CENTER
Mailing Address - Street 2:SUITE 365D
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-6261
Mailing Address - Country:US
Mailing Address - Phone:978-969-1623
Mailing Address - Fax:978-969-6945
Practice Address - Street 1:100 CUMMINGS CENTER
Practice Address - Street 2:365D
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915
Practice Address - Country:US
Practice Address - Phone:978-969-1623
Practice Address - Fax:978-969-6945
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA187314364SP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110079048AMedicaid