Provider Demographics
NPI:1659797801
Name:BERK, SUSAN H (MS)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:H
Last Name:BERK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3011 EUCLID HEIGHTS BLVD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-2025
Mailing Address - Country:US
Mailing Address - Phone:216-523-8498
Mailing Address - Fax:
Practice Address - Street 1:1440 LAKESIDE AVE E
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44114-1137
Practice Address - Country:US
Practice Address - Phone:216-523-8498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-12
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH440103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist