Provider Demographics
NPI:1447951009
Name:BERTSCH, THERESE M (DSW, LCSW)
Entity type:Individual
Prefix:DR
First Name:THERESE
Middle Name:M
Last Name:BERTSCH
Suffix:
Gender:F
Credentials:DSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 SAYVILLE BLVD
Mailing Address - Street 2:
Mailing Address - City:SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11782-2012
Mailing Address - Country:US
Mailing Address - Phone:631-664-0446
Mailing Address - Fax:
Practice Address - Street 1:202 SAYVILLE BLVD
Practice Address - Street 2:
Practice Address - City:SAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11782-2012
Practice Address - Country:US
Practice Address - Phone:631-664-0446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY074282-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical