Provider Demographics
NPI:1811049927
Name:BERVERA, CAROL A (LICSW)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:A
Last Name:BERVERA
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 1:33 KEYES ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01062-1416
Mailing Address - Country:US
Mailing Address - Phone:413-586-8493
Mailing Address - Fax:
Practice Address - Street 1:16 CENTER ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3031
Practice Address - Country:US
Practice Address - Phone:413-586-8493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1051261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1854615Medicaid
MAP03744OtherBLUE CROSS BLUE SHIELD
MA1895320OtherMBHP
MA1895320OtherMBHP