Provider Demographics
NPI:1184792541
Name:BERKWITZ, PAMELA MOSER (LICSW)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:MOSER
Last Name:BERKWITZ
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2425 FRANCE AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55416-3820
Mailing Address - Country:US
Mailing Address - Phone:952-920-3364
Mailing Address - Fax:
Practice Address - Street 1:13100 WAYZATA BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-1802
Practice Address - Country:US
Practice Address - Phone:952-546-0616
Practice Address - Fax:952-573-1778
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN108611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN226525700 600908500OtherMEDICAL ASSISTANCE
MN79B77BE 3G377LA SWOtherBLUE CROSS BLUE SHIELD
MN6249297OtherUBH & MEDICA
MN6249297OtherUBH & MEDICA