Provider Demographics
NPI:1457640104
Name:BERLIN, MIKE
Entity Type:Individual
Prefix:
First Name:MIKE
Middle Name:
Last Name:BERLIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 W HILLCREST DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-4264
Mailing Address - Country:US
Mailing Address - Phone:805-593-4222
Mailing Address - Fax:805-583-8064
Practice Address - Street 1:299 W HILLCREST DR
Practice Address - Street 2:SUITE 110
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-4264
Practice Address - Country:US
Practice Address - Phone:805-593-4222
Practice Address - Fax:805-583-8064
Is Sole Proprietor?:No
Enumeration Date:2011-04-04
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-10-7092103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst