Provider Demographics
NPI:1881164978
Name:BEREZHNOY, SERGIY (CO 60911229)
Entity type:Individual
Prefix:
First Name:SERGIY
Middle Name:
Last Name:BEREZHNOY
Suffix:
Gender:M
Credentials:CO 60911229
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14819 E MISSION AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-1960
Mailing Address - Country:US
Mailing Address - Phone:509-315-9812
Mailing Address - Fax:509-474-9612
Practice Address - Street 1:235 E ROWAN AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-1240
Practice Address - Country:US
Practice Address - Phone:509-252-6446
Practice Address - Fax:509-252-6490
Is Sole Proprietor?:No
Enumeration Date:2018-11-30
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC612006561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical