Provider Demographics
NPI:1740427574
Name:BERKOVITZ, TRUDY (MSW)
Entity Type:Individual
Prefix:MS
First Name:TRUDY
Middle Name:
Last Name:BERKOVITZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 WEST ST
Mailing Address - Street 2:
Mailing Address - City:NEW SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01355-9530
Mailing Address - Country:US
Mailing Address - Phone:978-544-7558
Mailing Address - Fax:978-544-7558
Practice Address - Street 1:257 WEST ST
Practice Address - Street 2:
Practice Address - City:NEW SALEM
Practice Address - State:MA
Practice Address - Zip Code:01355-9530
Practice Address - Country:US
Practice Address - Phone:978-544-7558
Practice Address - Fax:978-544-7558
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-15
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1056911041C0700X, 1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool