Provider Demographics
NPI:1649256900
Name:BERLIN, RICHARD M (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:M
Last Name:BERLIN
Suffix:
Gender:M
Credentials:MD
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 1932
Mailing Address - Street 2:
Mailing Address - City:LENOX
Mailing Address - State:MA
Mailing Address - Zip Code:01240-4932
Mailing Address - Country:US
Mailing Address - Phone:413-637-1325
Mailing Address - Fax:660-951-8043
Practice Address - Street 1:69 CHURCH ST
Practice Address - Street 2:
Practice Address - City:LENOX
Practice Address - State:MA
Practice Address - Zip Code:01240-2771
Practice Address - Country:US
Practice Address - Phone:413-637-1325
Practice Address - Fax:413-637-4265
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20341612084P0800X
MA510952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6188141Medicaid
MA6188141Medicaid