Provider Demographics
NPI:1376122671
Name:BERKOWICH, KRISTEN (LGSW)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:BERKOWICH
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:QUARRYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17566-9339
Mailing Address - Country:US
Mailing Address - Phone:443-350-0825
Mailing Address - Fax:
Practice Address - Street 1:111 RYAN DR
Practice Address - Street 2:
Practice Address - City:RISING SUN
Practice Address - State:MD
Practice Address - Zip Code:21911-1841
Practice Address - Country:US
Practice Address - Phone:410-642-9172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-05
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24248104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker