Provider Demographics
NPI:1518218627
Name:BERSCH, KRISTINE (LSW)
Entity Type:Individual
Prefix:MS
First Name:KRISTINE
Middle Name:
Last Name:BERSCH
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3910 MELVILLE CT
Mailing Address - Street 2:
Mailing Address - City:MAHWAH
Mailing Address - State:NJ
Mailing Address - Zip Code:07430-2308
Mailing Address - Country:US
Mailing Address - Phone:201-835-4361
Mailing Address - Fax:
Practice Address - Street 1:400D LAKE ST
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446-1279
Practice Address - Country:US
Practice Address - Phone:201-835-4361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-28
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05781700104100000X
1041C0700X
NJ44SC056571001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker