Provider Demographics
NPI:1386604247
Name:BERKE, ALICE (LICSW)
Entity type:Individual
Prefix:MS
First Name:ALICE
Middle Name:
Last Name:BERKE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:ALICE
Other - Middle Name:
Other - Last Name:BERKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LICSW
Mailing Address - Street 1:PO BOX 204
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:MD
Mailing Address - Zip Code:01245
Mailing Address - Country:US
Mailing Address - Phone:413-528-8206
Mailing Address - Fax:413-232-0111
Practice Address - Street 1:38 MAIN ST.
Practice Address - Street 2:
Practice Address - City:WEST STOCKBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01266
Practice Address - Country:US
Practice Address - Phone:413-528-8206
Practice Address - Fax:413-232-0111
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1102821041C0700X
NY0662781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP22760Medicare ID - Type Unspecified
NYN179K1Medicare ID - Type Unspecified