Provider Demographics
NPI:1790321974
Name:BEREZHNA, ZLATA
Entity type:Individual
Prefix:
First Name:ZLATA
Middle Name:
Last Name:BEREZHNA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1869 ROUTE 739
Mailing Address - Street 2:
Mailing Address - City:DINGMANS FERRY
Mailing Address - State:PA
Mailing Address - Zip Code:18328-3414
Mailing Address - Country:US
Mailing Address - Phone:570-730-6148
Mailing Address - Fax:
Practice Address - Street 1:1869 ROUTE 739
Practice Address - Street 2:
Practice Address - City:DINGMANS FERRY
Practice Address - State:PA
Practice Address - Zip Code:18328
Practice Address - Country:US
Practice Address - Phone:570-730-6148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-21
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW024216101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health