Provider Demographics
NPI:1881094571
Name:BERKOWITZ, MEGAN LOVE (LICSW)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:LOVE
Last Name:BERKOWITZ
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:LOVE
Other - Last Name:MALINCONICO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:355 I ST SW # S301
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20024-4230
Mailing Address - Country:US
Mailing Address - Phone:610-509-4626
Mailing Address - Fax:
Practice Address - Street 1:415 MICHIGAN AVE NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-4500
Practice Address - Country:US
Practice Address - Phone:202-656-7156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-29
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500800941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical