# BERKS THERAPEUTIC ALLIANCE

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Keystone Blue Hen PC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1497167167
- **Authorized official:** DR. SCOT MASON DEPUE M.D. (CEO)
- **Authorized official phone:** (484) 769-7626

## Contact information

- **Practice address:** 845 N PARK RD, SUITE 101, WYOMISSING, PA 19610-1342
- **Practice address phone:** (610) 334-8131
- **Mailing address:** 845 N PARK RD, SUITE 101, WYOMISSING, PA 19610-1342
- **Mailing address phone:** (610) 334-8131

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | MD426302 | PA | Yes |
| 103TA0400X | Addiction (Substance Use Disorder) Psychologist | PC002868 | PA | — |
| 207P00000X | Emergency Medicine Physician | MD426302 | PA | — |

## Other

- **Enumeration date:** 05/28/2014
- **Last updated:** 05/28/2014