Provider Demographics
NPI:1659666543
Name:JAMES BERWICK, LCSW
Entity Type:Organization
Organization Name:JAMES BERWICK, LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:BERWICK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:904-599-3602
Mailing Address - Street 1:505 22ND ST
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-1798
Mailing Address - Country:US
Mailing Address - Phone:904-599-3602
Mailing Address - Fax:904-461-8368
Practice Address - Street 1:505 22ND ST
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-1798
Practice Address - Country:US
Practice Address - Phone:904-599-3602
Practice Address - Fax:904-461-8368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-19
Last Update Date:2011-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW16921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL761949900Medicaid
FLZ4535OtherBCBS
FLZ4535XMedicare PIN