Provider Demographics
NPI:1467554816
Name:BERMAN, STANLEY JAY (PHD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:JAY
Last Name:BERMAN
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 1:56 WINTHROP ST
Mailing Address - Street 2:P.O. BOX 1356
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-2076
Mailing Address - Country:US
Mailing Address - Phone:978-369-5036
Mailing Address - Fax:617-327-4447
Practice Address - Street 1:56 WINTHROP ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-2076
Practice Address - Country:US
Practice Address - Phone:978-369-5036
Practice Address - Fax:617-327-4447
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3409103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist