Provider Demographics
NPI:1508930728
Name:BERMAN, REBECCA (RD LDN)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:
Last Name:BERMAN
Suffix:
Gender:F
Credentials:RD LDN
Other - Prefix:MISS
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:SAMUELS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD LDN
Mailing Address - Street 1:6719 ASHBURN RD
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-7320
Mailing Address - Country:US
Mailing Address - Phone:561-434-9799
Mailing Address - Fax:
Practice Address - Street 1:4847 FRED GLADSTONE DR
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33417-8023
Practice Address - Country:US
Practice Address - Phone:561-471-5111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 4746133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU6740ZMedicare ID - Type UnspecifiedREGISTERED DIETITIAN