Provider Demographics
NPI:1760044622
Name:BERKLEY, ROBERTA (LPC)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:
Last Name:BERKLEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:
Other - Last Name:BERKLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:1100 PATRICIA APT 512B
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-1328
Mailing Address - Country:US
Mailing Address - Phone:210-618-9445
Mailing Address - Fax:866-714-4029
Practice Address - Street 1:11550 W INTERSTATE 10 STE 235
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-1066
Practice Address - Country:US
Practice Address - Phone:210-618-9445
Practice Address - Fax:866-714-4029
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-01
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX75699101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional