Provider Demographics
NPI:1710639265
Name:BERKEBILE, ASHLEY (LAC, SAC)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:
Last Name:BERKEBILE
Suffix:
Gender:F
Credentials:LAC, SAC
Other - Prefix:MS
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:CAPICOTTO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC, SAC
Mailing Address - Street 1:786 MOUNTAIN BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:WATCHUNG
Mailing Address - State:NJ
Mailing Address - Zip Code:07069-6268
Mailing Address - Country:US
Mailing Address - Phone:908-322-9623
Mailing Address - Fax:
Practice Address - Street 1:786 MOUNTAIN BLVD STE 104
Practice Address - Street 2:
Practice Address - City:WATCHUNG
Practice Address - State:NJ
Practice Address - Zip Code:07069-6268
Practice Address - Country:US
Practice Address - Phone:908-322-9623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC000520100101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health