Provider Demographics
NPI:1770583932
Name:BERENSON, CLAUDIA (CHILD PSYCHIATRIST)
Entity type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:
Last Name:BERENSON
Suffix:
Gender:F
Credentials:CHILD PSYCHIATRIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 196276
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99519-6276
Mailing Address - Country:US
Mailing Address - Phone:907-550-2315
Mailing Address - Fax:
Practice Address - Street 1:4001 DALE ST STE 101
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5444
Practice Address - Country:US
Practice Address - Phone:907-550-2315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM90-1532084P0804X
AK54392084P0804X
UT152189-12052084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD3093Medicaid
AKMD3093Medicaid
AK0000WCHHHMedicare ID - Type UnspecifiedGROUP