Provider Demographics
NPI:1710309620
Name:BERKOWITZ, MARA JENNIFER (LAC LMT)
Entity Type:Individual
Prefix:MRS
First Name:MARA
Middle Name:JENNIFER
Last Name:BERKOWITZ
Suffix:
Gender:F
Credentials:LAC LMT
Other - Prefix:
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Mailing Address - Street 1:3430 SUNRISE HWY
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-4069
Mailing Address - Country:US
Mailing Address - Phone:516-697-7109
Mailing Address - Fax:
Practice Address - Street 1:3728 PARK AVE
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-3707
Practice Address - Country:US
Practice Address - Phone:516-697-7109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-11
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY27 014196225700000X
NY25 005235171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist