Provider Demographics
NPI:1447982996
Name:GRETCHEN A BERKOWITCH PMHCNS-BC
Entity type:Organization
Organization Name:GRETCHEN A BERKOWITCH PMHCNS-BC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GRETCHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BERKOWITCH
Authorized Official - Suffix:
Authorized Official - Credentials:PMHCNS-BC
Authorized Official - Phone:978-969-1623
Mailing Address - Street 1:100 CUMMINGS CTR STE 365D
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-6261
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 CUMMINGS CTR STE 365D
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6261
Practice Address - Country:US
Practice Address - Phone:978-969-1623
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-24
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & AdolescentGroup - Single Specialty