Provider Demographics
NPI:1851318802
Name:BEREN, GLORIA LYNDA (LMSW, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:LYNDA
Last Name:BEREN
Suffix:
Gender:F
Credentials:LMSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28511 ORCHARD LAKE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2933
Mailing Address - Country:US
Mailing Address - Phone:248-489-1550
Mailing Address - Fax:248-489-9767
Practice Address - Street 1:28511 ORCHARD LAKE RD
Practice Address - Street 2:SUITE A
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2933
Practice Address - Country:US
Practice Address - Phone:248-489-1550
Practice Address - Fax:248-489-9767
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801015392104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker