Provider Demographics
NPI:1578718524
Name:BERMAN, STACEY DANIELLE (MS, OTR/L)
Entity Type:Individual
Prefix:MS
First Name:STACEY
Middle Name:DANIELLE
Last Name:BERMAN
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:MRS
Other - First Name:STACEY
Other - Middle Name:DANIELLE
Other - Last Name:MANZINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS,OTR/L
Mailing Address - Street 1:1701 AUBURN RD
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-3512
Mailing Address - Country:US
Mailing Address - Phone:516-804-8222
Mailing Address - Fax:
Practice Address - Street 1:1701 AUBURN RD
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-3512
Practice Address - Country:US
Practice Address - Phone:516-804-8222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-18
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011919-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist