Provider Demographics
NPI:1093218448
Name:BERSON, EMILY JANE (MA)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:JANE
Last Name:BERSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:JANE
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:1515 S MOJAVE RD SPC 107
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-4532
Mailing Address - Country:US
Mailing Address - Phone:702-595-4498
Mailing Address - Fax:
Practice Address - Street 1:2801 S VALLEY VIEW BLVD STE 6
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-0166
Practice Address - Country:US
Practice Address - Phone:702-922-7015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-13
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMI0898106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist