Provider Demographics
NPI:1659450880
Name:BERRIAN, YVETTE JOAN (MSW LCSW BCD)
Entity Type:Individual
Prefix:MS
First Name:YVETTE
Middle Name:JOAN
Last Name:BERRIAN
Suffix:
Gender:F
Credentials:MSW LCSW BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 147
Mailing Address - Street 2:
Mailing Address - City:GLENSIDE
Mailing Address - State:PA
Mailing Address - Zip Code:19038-0147
Mailing Address - Country:US
Mailing Address - Phone:215-659-7872
Mailing Address - Fax:215-659-3714
Practice Address - Street 1:7301 OLD YORK ROAD
Practice Address - Street 2:
Practice Address - City:ELKINS PK
Practice Address - State:PA
Practice Address - Zip Code:19027
Practice Address - Country:US
Practice Address - Phone:215-659-7872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0134311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001664916OtherKEYSTONE
PA0475472OtherAMERI HEALTH
PA0475472000OtherPC
PA1256244Medicaid
PA0475472000OtherPC
PA1256244Medicaid