Provider Demographics
NPI:1235201906
Name:BERMAN, NICOLE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:BERMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 GLEN COVE AVE
Mailing Address - Street 2:SUITE 2 LOWER LEVEL
Mailing Address - City:GLEN HEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11545-1589
Mailing Address - Country:US
Mailing Address - Phone:516-586-5860
Mailing Address - Fax:516-586-5861
Practice Address - Street 1:80 GLEN HEAD RD
Practice Address - Street 2:SUITE 200
Practice Address - City:GLEN HEAD
Practice Address - State:NY
Practice Address - Zip Code:11545-1933
Practice Address - Country:US
Practice Address - Phone:516-586-5860
Practice Address - Fax:516-586-5861
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2015-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016931103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical