Provider Demographics
NPI:1578093456
Name:BERAK, GERALDINE (MS BCBA LABA)
Entity type:Individual
Prefix:
First Name:GERALDINE
Middle Name:
Last Name:BERAK
Suffix:
Gender:F
Credentials:MS BCBA LABA
Other - Prefix:
Other - First Name:GERALDINE
Other - Middle Name:
Other - Last Name:LORBES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS BCBA LABA
Mailing Address - Street 1:205 BURLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01730-1406
Mailing Address - Country:US
Mailing Address - Phone:781-862-3600
Mailing Address - Fax:
Practice Address - Street 1:301 EDGEWATER PL STE 100
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-1281
Practice Address - Country:US
Practice Address - Phone:617-855-1954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12044174103K00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA99618201OtherNETWORK HEALTH
MAM18633OtherBCBS
MA042611055OtherTAX ID
MA0000023532OtherBMC
MA110026265EMedicaid
MA1303287OtherMBHP
MA1004745OtherNHP
MA1004745OtherFALLON