Provider Demographics
NPI:1417655580
Name:BERKOWITZ, SAMANTHA (MPH, RD, LDN)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:BERKOWITZ
Suffix:
Gender:F
Credentials:MPH, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 S LEXINGTON AVE
Mailing Address - Street 2:SUITE 101, PMB# 151
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-4657
Mailing Address - Country:US
Mailing Address - Phone:828-820-5455
Mailing Address - Fax:
Practice Address - Street 1:125 S LEXINGTON AVE STE 101
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-3661
Practice Address - Country:US
Practice Address - Phone:828-820-5455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL007052133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered