Provider Demographics
NPI:1912958943
Name:BERLIN, JOAN W (LICSW)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:W
Last Name:BERLIN
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 1:1121 WASHINGTON ST
Mailing Address - Street 2:STE 4
Mailing Address - City:WEST NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02465-2150
Mailing Address - Country:US
Mailing Address - Phone:617-620-9202
Mailing Address - Fax:
Practice Address - Street 1:1121 WASHINGTON ST
Practice Address - Street 2:STE 4
Practice Address - City:WEST NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02465-2150
Practice Address - Country:US
Practice Address - Phone:617-620-9202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA102243104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA669490OtherTUFTS HEALTH PLAN
MA0014260OtherNEIGHBORHOOD HEALTH PLAN
MAP02067OtherBLUE CROSS
MAP02067OtherBLUE CROSS