Provider Demographics
NPI:1881082428
Name:BERKOVITZ, HOLLY (CAPSW)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:BERKOVITZ
Suffix:
Gender:F
Credentials:CAPSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 OVERLOOK TER
Mailing Address - Street 2:HBPC
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-2254
Mailing Address - Country:US
Mailing Address - Phone:888-478-8321
Mailing Address - Fax:608-830-6656
Practice Address - Street 1:3220 DEMING WAY
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-1498
Practice Address - Country:US
Practice Address - Phone:888-478-8323
Practice Address - Fax:608-830-6656
Is Sole Proprietor?:No
Enumeration Date:2015-01-06
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI129529-121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker