Provider Demographics
NPI:1346754744
Name:SUMMERS, BERTA JANE (PHD)
Entity Type:Individual
Prefix:DR
First Name:BERTA
Middle Name:JANE
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 NORTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-6730
Mailing Address - Country:US
Mailing Address - Phone:617-903-0550
Mailing Address - Fax:
Practice Address - Street 1:30 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-6730
Practice Address - Country:US
Practice Address - Phone:617-903-0550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-21
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5782103T00000X
MA11115103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist