Provider Demographics
NPI:1386066876
Name:BERKSON, REBECCA (LAC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:BERKSON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 HOMERIC CT
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-5611
Mailing Address - Country:US
Mailing Address - Phone:703-731-9509
Mailing Address - Fax:
Practice Address - Street 1:1405 HOMERIC CT
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-5611
Practice Address - Country:US
Practice Address - Phone:703-731-9509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-17
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000724171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist