Basic Information
| Provider Information | |||||||||
| NPI: | 1669657953 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BERKOWITZ-GOSSELIN | ||||||||
| FirstName: | LEAH | ||||||||
| MiddleName: | |||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1402 | ||||||||
| Address2: | |||||||||
| City: | NORTHAMPTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010611402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137945700 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 24 N MAPLE ST STE 5 | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010621323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4132067692 | ||||||||
| FaxNumber: | 5084331871 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2008 | ||||||||
| LastUpdateDate: | 11/18/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 115913 | MA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.