Provider Demographics
NPI:1376686741
Name:BERMAN, MARCIE ANNE (PHD)
Entity Type:Individual
Prefix:
First Name:MARCIE
Middle Name:ANNE
Last Name:BERMAN
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 1:1509 UPLAND AVE
Mailing Address - Street 2:
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-2306
Mailing Address - Country:US
Mailing Address - Phone:215-886-8233
Mailing Address - Fax:
Practice Address - Street 1:1509 UPLAND AVE
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-2306
Practice Address - Country:US
Practice Address - Phone:215-886-8233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS 00 3993-L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPS 00 3993-LOtherSTATE PSYCHOLOGY LICENSE