Provider Demographics
NPI:1750560199
Name:R. BERKE & ASSOCIATES, P.A.
Entity type:Organization
Organization Name:R. BERKE & ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BERKE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:603-672-4150
Mailing Address - Street 1:82A PONEMAH RD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NH
Mailing Address - Zip Code:03031-3110
Mailing Address - Country:US
Mailing Address - Phone:603-672-4150
Mailing Address - Fax:
Practice Address - Street 1:82A PONEMAH RD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NH
Practice Address - Zip Code:03031-3110
Practice Address - Country:US
Practice Address - Phone:603-672-4150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH113103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH83622837Medicaid
NHRE1454Medicare PIN