Provider Demographics
NPI:1134805336
Name:BERL, JENNIFER SMITH (MA, LPC, NCC)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:SMITH
Last Name:BERL
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 N ORKNEY ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19122-1340
Mailing Address - Country:US
Mailing Address - Phone:215-378-6849
Mailing Address - Fax:
Practice Address - Street 1:206 LAKESIDE PARK
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-4049
Practice Address - Country:US
Practice Address - Phone:267-682-7823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC-014429101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional