Provider Demographics
NPI:1679885024
Name:BERBERICH, JENNIFER IRENE (LCSW-C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:IRENE
Last Name:BERBERICH
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:IRENE
Other - Last Name:SITARIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3100 F MOUNTAIN RD.
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122
Mailing Address - Country:US
Mailing Address - Phone:410-841-9647
Mailing Address - Fax:614-355-8361
Practice Address - Street 1:3100 F MOUNTAIN RD.
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122
Practice Address - Country:US
Practice Address - Phone:410-841-9647
Practice Address - Fax:614-355-8361
Is Sole Proprietor?:No
Enumeration Date:2010-07-13
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
217461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH08258Medicaid