Provider Demographics
NPI:1548245863
Name:BERDINE, ROSEMARY D (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ROSEMARY
Middle Name:D
Last Name:BERDINE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 COMMERCIAL ST
Mailing Address - Street 2:PO BOX 87
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-4333
Mailing Address - Country:US
Mailing Address - Phone:503-325-5844
Mailing Address - Fax:503-325-2821
Practice Address - Street 1:174 COMMERCIAL STREET
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-6237
Practice Address - Country:US
Practice Address - Phone:503-325-5844
Practice Address - Fax:503-325-2821
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-09
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1021103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR93-145602OtherTIN