Provider Demographics
NPI:1912049032
Name:BERK, RONALD J (MEQ, LP)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:J
Last Name:BERK
Suffix:
Gender:M
Credentials:MEQ, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5212 ABERCROMBIE DR
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-1451
Mailing Address - Country:US
Mailing Address - Phone:952-944-7284
Mailing Address - Fax:
Practice Address - Street 1:2104 NORTHDALE BLVD NW
Practice Address - Street 2:SUITE 220
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55433-3028
Practice Address - Country:US
Practice Address - Phone:763-537-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP0981103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN965747900OtherMINNESOTA PROVIDER NUMBR