Provider Demographics
NPI:1982797221
Name:BERK, JUDITH (LCSW-C)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:BERK
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3418 MIDFIELD RD
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-4407
Mailing Address - Country:US
Mailing Address - Phone:410-446-4158
Mailing Address - Fax:
Practice Address - Street 1:3418 MIDFIELD RD
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-4407
Practice Address - Country:US
Practice Address - Phone:410-446-4158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-01
Last Update Date:2023-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD079621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD225627OtherMEDICARE
MD245CJA 61040002OtherCAREFIRST
DCK835 0001OtherCAREFIRST
MD225627OtherMEDICARE