Provider Demographics
NPI:1508330218
Name:BERLETH, HANNA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:HANNA
Middle Name:
Last Name:BERLETH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 WALNUT ST STE 810
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-3505
Mailing Address - Country:US
Mailing Address - Phone:267-652-1668
Mailing Address - Fax:
Practice Address - Street 1:1500 WALNUT ST STE 810
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-3505
Practice Address - Country:US
Practice Address - Phone:917-579-2923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-15
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS018725103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical