Provider Demographics
NPI:1336280056
Name:BERKOWITZ, FLORENCE GLORIA (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:FLORENCE
Middle Name:GLORIA
Last Name:BERKOWITZ
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 HAMMOND POND PKWY
Mailing Address - Street 2:APT. 614 S
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-1533
Mailing Address - Country:US
Mailing Address - Phone:617-965-0273
Mailing Address - Fax:
Practice Address - Street 1:250 HAMMOND POND PKWY
Practice Address - Street 2:APT. 614 S
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-1533
Practice Address - Country:US
Practice Address - Phone:617-965-0273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1067551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP04332Medicare ID - Type UnspecifiedLICSW