Provider Demographics
NPI:1922754902
Name:BERKE, ANNA (LCSW)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:BERKE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8322 SE 162ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97236-4830
Mailing Address - Country:US
Mailing Address - Phone:541-729-3631
Mailing Address - Fax:
Practice Address - Street 1:CALLE MANUEL PLASCENCIA 10
Practice Address - Street 2:
Practice Address - City:SAYULITA
Practice Address - State:NAYARIT
Practice Address - Zip Code:63734
Practice Address - Country:MX
Practice Address - Phone:541-729-3631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-28
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL5460101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health