Provider Demographics
NPI:1477760007
Name:BERKOWITZ, SHOSHANA AMI (MED)
Entity Type:Individual
Prefix:MS
First Name:SHOSHANA
Middle Name:AMI
Last Name:BERKOWITZ
Suffix:
Gender:F
Credentials:MED
Other - Prefix:MS
Other - First Name:S.
Other - Middle Name:AMI
Other - Last Name:BERKOWITZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:M ED
Mailing Address - Street 1:350 S MAIN ST
Mailing Address - Street 2:SUITE 111
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18901-4871
Mailing Address - Country:US
Mailing Address - Phone:215-643-6151
Mailing Address - Fax:215-643-6575
Practice Address - Street 1:350 S MAIN ST
Practice Address - Street 2:SUITE 111
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901-4871
Practice Address - Country:US
Practice Address - Phone:215-643-6151
Practice Address - Fax:215-643-6575
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS007936L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist