Provider Demographics
NPI:1295795375
Name:BERKE, HEIDI A (LICSW)
Entity type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:A
Last Name:BERKE
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:PO BOX 750063
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:MA
Mailing Address - Zip Code:02475-0063
Mailing Address - Country:US
Mailing Address - Phone:617-504-6624
Mailing Address - Fax:
Practice Address - Street 1:200 GREAT RD
Practice Address - Street 2:SUITE 232
Practice Address - City:BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:01730-2711
Practice Address - Country:US
Practice Address - Phone:617-504-6624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10167491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP06719Medicare ID - Type Unspecified