Provider Demographics
NPI:1114005444
Name:BERMAN, ELLEN (LCSW)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:BERMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2290 W COUNTY LINE RD
Mailing Address - Street 2:SUITE 206A
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-2267
Mailing Address - Country:US
Mailing Address - Phone:732-370-5355
Mailing Address - Fax:732-370-5344
Practice Address - Street 1:2290 W COUNTY LINE RD
Practice Address - Street 2:SUITE 206A
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-2267
Practice Address - Country:US
Practice Address - Phone:732-370-5355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC043109001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
046311PSYMedicare ID - Type Unspecified