Provider Demographics
NPI:1164692182
Name:BEDERMAN, EVAN BERWIN (LMHC)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:BERWIN
Last Name:BEDERMAN
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9850 67TH AVE
Mailing Address - Street 2:APT. 3H
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4965
Mailing Address - Country:US
Mailing Address - Phone:917-488-2073
Mailing Address - Fax:
Practice Address - Street 1:9850 67TH AVE
Practice Address - Street 2:APT. 3H
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-4965
Practice Address - Country:US
Practice Address - Phone:917-488-2073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-05
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003023-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health