Provider Demographics
NPI:1467530519
Name:BERMAN, JODI CAROL (PHD)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:CAROL
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 1:625 TOWNE HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-1894
Mailing Address - Country:US
Mailing Address - Phone:201-248-7361
Mailing Address - Fax:
Practice Address - Street 1:179 POST RD W
Practice Address - Street 2:2ND FLOOR
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-4602
Practice Address - Country:US
Practice Address - Phone:201-248-7361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017830103T00000X
CT003295103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist