Berks Therapeutic Alliance

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

MD426302 Issued in PA

Legal business name

BERKS THERAPEUTIC ALLIANCE

Practice address

845 N Park Rd
Suite 101
Wyomissing, PA 19610-1342

Phone

(610) 334-8131

NPI assigned

May 28, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Scot Mason Depue, M.D.

Title

Ceo

Phone

(484) 769-7626

Specialties & licenses 3

Addresses

Other names 1

• Keystone Blue Hen PC Other name

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1401235200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1401235200000",
    "number": "1497167167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "845 N PARK RD",
            "address_2": "SUITE 101",
            "city": "WYOMISSING",
            "state": "PA",
            "postal_code": "196101342",
            "telephone_number": "610-334-8131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "845 N PARK RD",
            "address_2": "SUITE 101",
            "city": "WYOMISSING",
            "state": "PA",
            "postal_code": "196101342",
            "telephone_number": "610-334-8131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BERKS THERAPEUTIC ALLIANCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-28",
        "last_updated": "2014-05-28",
        "status": "A",
        "authorized_official_last_name": "DEPUE",
        "authorized_official_first_name": "SCOT",
        "authorized_official_middle_name": "MASON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "484-769-7626",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "PA",
            "license": "MD426302",
            "primary": true
        },
        {
            "code": "103TA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": "PA",
            "license": "PC002868",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": "PA",
            "license": "MD426302",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Keystone Blue Hen PC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Addiction (Substance Use Disorder) Counselor in Wyomissing, PA
• Providers in Wyomissing, PA by specialty
• Addiction (Substance Use Disorder) Counselor in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.