Provider Demographics
NPI:1730236514
Name:REBEKAH L BERKOWITZ & ASSOC INC
Entity type:Organization
Organization Name:REBEKAH L BERKOWITZ & ASSOC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:REBEKAH
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:BERKOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:314-845-0673
Mailing Address - Street 1:4167 CRESCENT DR. #103C
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129-1071
Mailing Address - Country:US
Mailing Address - Phone:314-845-0673
Mailing Address - Fax:
Practice Address - Street 1:4167 CRESCENT DR STE 103C
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-3643
Practice Address - Country:US
Practice Address - Phone:314-845-0673
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOSW0000541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000013978Medicare ID - Type Unspecified
MOR01003Medicare UPIN