Provider Demographics
NPI:1639410442
Name:BARTOLIN, BERTH (MA, LPC)
Entity Type:Individual
Prefix:
First Name:BERTH
Middle Name:
Last Name:BARTOLIN
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 GYPSY LN UNIT 504
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-5431
Mailing Address - Country:US
Mailing Address - Phone:267-968-9263
Mailing Address - Fax:
Practice Address - Street 1:6703 GERMANTOWN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-2109
Practice Address - Country:US
Practice Address - Phone:215-337-4813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-05
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC006070101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional