Provider Demographics
NPI:1689822090
Name:BERG, EMILY PERKINS (MSW, LICSW)
Entity Type:Individual
Prefix:MS
First Name:EMILY
Middle Name:PERKINS
Last Name:BERG
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 DORCHESTER AVE
Mailing Address - Street 2:KIT CLARK SENIOR SERVICES
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02122-1327
Mailing Address - Country:US
Mailing Address - Phone:617-619-6962
Mailing Address - Fax:617-350-3499
Practice Address - Street 1:1500 DORCHESTER AVE
Practice Address - Street 2:KIT CLARK SENIOR SERVICES
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02122-1327
Practice Address - Country:US
Practice Address - Phone:617-619-6962
Practice Address - Fax:617-350-3499
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1145991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical