Provider Demographics
NPI:1457647851
Name:BERREN, MICHAEL ROBERT (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ROBERT
Last Name:BERREN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4901 E 5TH STREET
Mailing Address - Street 2:
Mailing Address - City:TUCSON,
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-2203
Mailing Address - Country:US
Mailing Address - Phone:520-202-1840
Mailing Address - Fax:520-318-9094
Practice Address - Street 1:4901 E 5TH STREET
Practice Address - Street 2:
Practice Address - City:TUCSON,
Practice Address - State:AZ
Practice Address - Zip Code:85711-2203
Practice Address - Country:US
Practice Address - Phone:520-202-1840
Practice Address - Fax:520-318-9094
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0730103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist