Provider Demographics
NPI:1326035569
Name:BERMAN, MARC ELLIOT (MSW)
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:ELLIOT
Last Name:BERMAN
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 326
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:MA
Mailing Address - Zip Code:02030-0326
Mailing Address - Country:US
Mailing Address - Phone:508-785-2319
Mailing Address - Fax:508-785-3221
Practice Address - Street 1:30 SPRINGDALE AVE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:MA
Practice Address - Zip Code:02030-2374
Practice Address - Country:US
Practice Address - Phone:508-785-2319
Practice Address - Fax:508-785-3221
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1024291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS021326OtherCHAMPIS
MAS021326OtherCHAMPIS