Provider Demographics
NPI:1750489514
Name:BERZINS, JURIS IMANIS (PHD)
Entity Type:Individual
Prefix:
First Name:JURIS
Middle Name:IMANIS
Last Name:BERZINS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-2509
Mailing Address - Country:US
Mailing Address - Phone:860-521-2515
Mailing Address - Fax:860-521-8291
Practice Address - Street 1:91 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-2509
Practice Address - Country:US
Practice Address - Phone:860-521-2515
Practice Address - Fax:860-521-8291
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001367103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT219158786OtherUBH
CT67235OtherCIGNA
CT060001367CT08OtherBCBS
CT7328626002OtherVALUE OPT GHI NO