Provider Demographics
NPI:1427190792
Name:BERMAN, SUSAN G (LISW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:G
Last Name:BERMAN
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26567 HENDON RD
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-2429
Mailing Address - Country:US
Mailing Address - Phone:216-765-0095
Mailing Address - Fax:
Practice Address - Street 1:29325 CHAGRIN BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4600
Practice Address - Country:US
Practice Address - Phone:216-789-7409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI00030971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHBESW12583Medicare ID - Type UnspecifiedLISW