Provider Demographics
NPI:1841665809
Name:BERKOWITZ, LAURA (BCBA-M)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:BERKOWITZ
Suffix:
Gender:F
Credentials:BCBA-M
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5132 N PALM AVE
Mailing Address - Street 2:BOX #303
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93704-2236
Mailing Address - Country:US
Mailing Address - Phone:559-475-7860
Mailing Address - Fax:559-475-7862
Practice Address - Street 1:1630 E SHAW AVE
Practice Address - Street 2:STE 190
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-8105
Practice Address - Country:US
Practice Address - Phone:559-475-7860
Practice Address - Fax:559-475-7862
Is Sole Proprietor?:No
Enumeration Date:2015-12-02
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst