Provider Demographics
NPI:1104851468
Name:BERMAN, MARK MITCHELL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:MITCHELL
Last Name:BERMAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1926 WESTOVER RD
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-1953
Mailing Address - Country:US
Mailing Address - Phone:215-266-4257
Mailing Address - Fax:
Practice Address - Street 1:1926 WESTOVER RD
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-1953
Practice Address - Country:US
Practice Address - Phone:215-266-4257
Practice Address - Fax:215-736-0099
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS015007101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY$$$$$$$$$OtherSOCIAL SECURITY
PA591319000OtherMIS NUMBER
NY125405201OtherSOCIAL SECURITY