Provider Demographics
NPI:1083047385
Name:BERMAN, REBECCA MICHELLE (PMHNP)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:MICHELLE
Last Name:BERMAN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5215 NE 52ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97218-1907
Mailing Address - Country:US
Mailing Address - Phone:503-939-6867
Mailing Address - Fax:
Practice Address - Street 1:6034 NE SANDY BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-3963
Practice Address - Country:US
Practice Address - Phone:503-939-6867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-10
Last Update Date:2013-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201391438NP-PP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health