Provider Demographics
NPI:1699750885
Name:BERK, ELLEN (LCSW, BCD)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:BERK
Suffix:
Gender:F
Credentials:LCSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7700 E ARAPAHOE RD
Mailing Address - Street 2:STE 260
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-1266
Mailing Address - Country:US
Mailing Address - Phone:303-796-7908
Mailing Address - Fax:303-796-7115
Practice Address - Street 1:7700 E ARAPAHOE RD
Practice Address - Street 2:STE 260
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-1266
Practice Address - Country:US
Practice Address - Phone:303-796-7908
Practice Address - Fax:303-796-7115
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-09
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9911541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC61866Medicare PIN