Provider Demographics
NPI:1790321974
Name:BEREZHNA, ZLATA
Entity Type:Individual
Prefix:
First Name:ZLATA
Middle Name:
Last Name:BEREZHNA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 N 5TH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-2609
Mailing Address - Country:US
Mailing Address - Phone:570-424-5100
Mailing Address - Fax:570-730-4214
Practice Address - Street 1:1300 N 5TH ST STE 102
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-2609
Practice Address - Country:US
Practice Address - Phone:570-424-5100
Practice Address - Fax:570-730-4214
Is Sole Proprietor?:No
Enumeration Date:2019-11-21
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW135717101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health