Provider Demographics
NPI:1548219546
Name:BEHRMAN, SAMUEL ALAN (PHD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:ALAN
Last Name:BEHRMAN
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 1:3044 BRISTLEWOOD LN NW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-5111
Mailing Address - Country:US
Mailing Address - Phone:205-478-1081
Mailing Address - Fax:
Practice Address - Street 1:1640 POWERS FERRY ROAD SE, BUILDING 9
Practice Address - Street 2:SUITE 100
Practice Address - City:MARIETTTA
Practice Address - State:GA
Practice Address - Zip Code:30067-5491
Practice Address - Country:US
Practice Address - Phone:770-953-0080
Practice Address - Fax:770-953-0031
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003028103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical