Provider Demographics
NPI:1417460296
Name:BERKLEY, SEAN ISAAC (LMSW)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:ISAAC
Last Name:BERKLEY
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4808 GRAY FOX DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-4217
Mailing Address - Country:US
Mailing Address - Phone:512-300-3062
Mailing Address - Fax:512-233-2598
Practice Address - Street 1:601 W 18TH ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-1111
Practice Address - Country:US
Practice Address - Phone:512-300-3062
Practice Address - Fax:512-233-2598
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX608871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical