Provider Demographics
NPI:1457311771
Name:BERKOWITZ, ELLIS DAVID (MSW, ACSW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:ELLIS
Middle Name:DAVID
Last Name:BERKOWITZ
Suffix:
Gender:M
Credentials:MSW, ACSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 WATERFORD PROFESSIONAL CTR STE 6C
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9300
Mailing Address - Country:US
Mailing Address - Phone:717-870-6563
Mailing Address - Fax:717-755-2322
Practice Address - Street 1:2 WATERFORD PROFESSIONAL CTR STE 6C
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-9300
Practice Address - Country:US
Practice Address - Phone:717-870-6563
Practice Address - Fax:717-755-2322
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0139291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA5313583OtherAETNA BEHAVIORAL HEALTH
PA339588OtherMAGELLAN BEH HEALTH
PA109828OtherVALUE OPTIONS
PA50003579OtherCAPITAL BLUE CROSS
PA5313583OtherAETNA BEHAVIORAL HEALTH