Provider Demographics
NPI:1861716714
Name:BERKSHIRE INTEGRATIVE HEALTHCARE LLC
Entity type:Organization
Organization Name:BERKSHIRE INTEGRATIVE HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:KISIEL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:413-442-0085
Mailing Address - Street 1:42 SUMMER ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-4526
Mailing Address - Country:US
Mailing Address - Phone:413-442-0085
Mailing Address - Fax:413-464-9143
Practice Address - Street 1:42 SUMMER ST
Practice Address - Street 2:SUITE 301
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-4526
Practice Address - Country:US
Practice Address - Phone:413-442-0085
Practice Address - Fax:413-464-9143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-22
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4907LMHC103TC1900X
MA9592225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty