Provider Demographics
NPI:1689050304
Name:BERKOSKI, KRYSTLE L (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KRYSTLE
Middle Name:L
Last Name:BERKOSKI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:KRYSTLE
Other - Middle Name:
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1330 MAIN ST # 247
Mailing Address - Street 2:
Mailing Address - City:DICKSON CITY
Mailing Address - State:PA
Mailing Address - Zip Code:18519-1368
Mailing Address - Country:US
Mailing Address - Phone:570-212-9782
Mailing Address - Fax:
Practice Address - Street 1:1330 MAIN ST # 247
Practice Address - Street 2:
Practice Address - City:DICKSON CITY
Practice Address - State:PA
Practice Address - Zip Code:18519-1368
Practice Address - Country:US
Practice Address - Phone:570-212-9782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-04
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS018309103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical