Provider Demographics
NPI:1114419413
Name:BERMAN, RYAN (MSW, RBT)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:BERMAN
Suffix:
Gender:M
Credentials:MSW, RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1940 MALCOLM AVE APT 208
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-4772
Mailing Address - Country:US
Mailing Address - Phone:310-909-9641
Mailing Address - Fax:
Practice Address - Street 1:400 PICO BLVD
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-1177
Practice Address - Country:US
Practice Address - Phone:310-314-5201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-01
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARBT-17-35506106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician