Provider Demographics
NPI:1609965391
Name:BERK, ELIZABETH CARLETON (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:CARLETON
Last Name:BERK
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 CASIE LN
Mailing Address - Street 2:
Mailing Address - City:WESTFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01886-4062
Mailing Address - Country:US
Mailing Address - Phone:978-413-9445
Mailing Address - Fax:
Practice Address - Street 1:11 CASIE LN
Practice Address - Street 2:
Practice Address - City:WESTFORD
Practice Address - State:MA
Practice Address - Zip Code:01886-4062
Practice Address - Country:US
Practice Address - Phone:978-413-9445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1025453101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health