1205372539 NPI number — MATTHEW BERKOWITZ L.S.W.

Table of content: MATTHEW BERKOWITZ L.S.W. (NPI 1205372539)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205372539 NPI number — MATTHEW BERKOWITZ L.S.W.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BERKOWITZ
Provider First Name:
MATTHEW
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
L.S.W.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205372539
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/10/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 W MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLEETWOOD
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19522-1323
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-944-0445
Provider Business Mailing Address Fax Number:
610-944-8834

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
319 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOWANDA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18848-1805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-268-3073
Provider Business Practice Location Address Fax Number:
570-268-3080
Provider Enumeration Date:
01/10/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  SW133508 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)