Provider Demographics
NPI:1710572706
Name:BERK, ROBIN (SW-T)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:BERK
Suffix:
Gender:F
Credentials:SW-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 N SUMMIT ST STE 2
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1884
Mailing Address - Country:US
Mailing Address - Phone:419-693-9600
Mailing Address - Fax:
Practice Address - Street 1:830 N SUMMIT ST STE 2
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43604-1884
Practice Address - Country:US
Practice Address - Phone:419-693-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS2101759390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program