Provider Demographics
NPI:1457442048
Name:BERK, DEBORAH BOND (LICSW)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:BOND
Last Name:BERK
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 1:236 GLEN RD
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:MA
Mailing Address - Zip Code:02493-2237
Mailing Address - Country:US
Mailing Address - Phone:781-431-7792
Mailing Address - Fax:781-431-9622
Practice Address - Street 1:236 GLEN RD
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:MA
Practice Address - Zip Code:02493-2237
Practice Address - Country:US
Practice Address - Phone:781-431-7792
Practice Address - Fax:781-431-9622
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1022381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA254992OtherMAGELLAN BEHAVIORAL
MAP02550OtherBLUE SHIELD OF MASS