Provider Demographics
NPI:1215699921
Name:BERKSHIRE GREENLEAF & WELLNESS, LLC
Entity type:Organization
Organization Name:BERKSHIRE GREENLEAF & WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MARLEE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:TYSKA
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LICSW
Authorized Official - Phone:413-329-8480
Mailing Address - Street 1:44 MCKINLEY TER
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-6608
Mailing Address - Country:US
Mailing Address - Phone:413-329-8480
Mailing Address - Fax:
Practice Address - Street 1:44 MCKINLEY TER
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-6608
Practice Address - Country:US
Practice Address - Phone:413-329-8480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-10
Last Update Date:2021-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty