Provider Demographics
NPI:1649080771
Name:BERWISE, CLIFTON A (PHD)
Entity type:Individual
Prefix:DR
First Name:CLIFTON
Middle Name:A
Last Name:BERWISE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 WARWICK RD N
Mailing Address - Street 2:
Mailing Address - City:LAWNSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:08045-1024
Mailing Address - Country:US
Mailing Address - Phone:917-497-1551
Mailing Address - Fax:
Practice Address - Street 1:300 CREEK VIEW RD STE 101
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-8547
Practice Address - Country:US
Practice Address - Phone:302-307-3702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-10
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEB1-0011339103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist