Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Addiction (Substance Use Disorder) |
101YA0400X | |||
Addiction (Substance Use Disorder) |
103TA0400X | 62 | Psychologist, Clinical | |
Emergency Medicine |
207P00000X | 93 | Physician/Emergency Medicine |
| NPI # | 1497167167 |
||||||||
| LBN Legal business name | BERKS THERAPEUTIC ALLIANCE | ||||||||
| Authorized official | SCOT DEPUE - (CEO) | ||||||||
| Entity | Organization | ||||||||
| Organization subpart 1 | No | ||||||||
| Enumeration date | 05/28/2014 | ||||||||
| Last updated | 05/28/2014 - About 12 years ago | ||||||||
| Identifiers |
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