Provider Demographics
NPI:1912029067
Name:BERLYN, STEVE (LISW ACSW)
Entity Type:Individual
Prefix:
First Name:STEVE
Middle Name:
Last Name:BERLYN
Suffix:
Gender:M
Credentials:LISW ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1807 SECOND STREET
Mailing Address - Street 2:#44C
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505
Mailing Address - Country:US
Mailing Address - Phone:505-984-1306
Mailing Address - Fax:
Practice Address - Street 1:1807 SECOND STREET
Practice Address - Street 2:#44C
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505
Practice Address - Country:US
Practice Address - Phone:505-984-1306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM97136Medicaid