Provider Demographics
NPI:1598988081
Name:BERKLEY, JOHN HUDSON (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HUDSON
Last Name:BERKLEY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:DR
Other - First Name:JACK
Other - Middle Name:HUDSON
Other - Last Name:BERKLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:564 STEAMBOAT RUN RD
Mailing Address - Street 2:
Mailing Address - City:SHEPHERDSTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25443
Mailing Address - Country:US
Mailing Address - Phone:304-876-1765
Mailing Address - Fax:304-876-1766
Practice Address - Street 1:129 E GERMAN STREET
Practice Address - Street 2:
Practice Address - City:SHEPHERDSTOWN
Practice Address - State:WV
Practice Address - Zip Code:25443
Practice Address - Country:US
Practice Address - Phone:304-876-1765
Practice Address - Fax:304-876-1766
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV728103T00000X
MD03431103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD269798OtherMAMSI