Provider Demographics
NPI:1619986270
Name:BERKE, DEBBIE
Entity Type:Individual
Prefix:MS
First Name:DEBBIE
Middle Name:
Last Name:BERKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 WALNUT AVE APT 83
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-4243
Mailing Address - Country:US
Mailing Address - Phone:916-483-8747
Mailing Address - Fax:
Practice Address - Street 1:5777 MADISON AVE STE 240
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95841-3308
Practice Address - Country:US
Practice Address - Phone:916-344-0964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 42466106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist