Provider Demographics
NPI:1669488177
Name:BERKOWITZ, LINDA L (LICSW,ACSW,BCD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:L
Last Name:BERKOWITZ
Suffix:
Gender:F
Credentials:LICSW,ACSW,BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 BRACKETT RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02458-2613
Mailing Address - Country:US
Mailing Address - Phone:617-527-0715
Mailing Address - Fax:617-244-0503
Practice Address - Street 1:125 BRACKETT RD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02458-2613
Practice Address - Country:US
Practice Address - Phone:617-527-0715
Practice Address - Fax:617-244-0503
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1023921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP04955Medicare ID - Type Unspecified