Basic Information
Provider Information | |||||||||
NPI: | 1356377410 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BERKOWITZ | ||||||||
FirstName: | KAREN | ||||||||
MiddleName: | S | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MSW, LCSW | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | WEISSMAN | ||||||||
OtherFirstName: | KAREN | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MSW, LCSW | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 1803 MOUNT ROSE AVE | ||||||||
Address2: | SUITE B3 | ||||||||
City: | YORK | ||||||||
State: | PA | ||||||||
PostalCode: | 174033026 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7178511405 | ||||||||
FaxNumber: | 7178516349 | ||||||||
Practice Location | |||||||||
Address1: | 3550 CONCORD RD | ||||||||
Address2: | SUITE 4 | ||||||||
City: | YORK | ||||||||
State: | PA | ||||||||
PostalCode: | 174028626 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7178516340 | ||||||||
FaxNumber: | 7178516349 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/23/2006 | ||||||||
LastUpdateDate: | 02/02/2012 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | CW012367 | PA | N |   | Behavioral Health & Social Service Providers | Social Worker |   | 1041C0700X | CW012367 | PA | Y |   | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
ID | Type | State | Issuer | Description | 0553950 | 05 | PA |   | MEDICAID | 293391 | 01 | PA | MAMSI | OTHER | 455627 | 01 | PA | VALUE OPTIONS | OTHER | 675137 | 01 | PA | PABS (FEP ONLY) | OTHER | 01090401 | 01 | PA | CAPITAL BLUE CROSS | OTHER | 2176821 | 01 | PA | CIGNA BEHAVIORAL HEALTH | OTHER | 169628000 | 01 | PA | MAGELLAN | OTHER |