Provider Demographics
NPI:1598200107
Name:BERMAN, JUDITH CARLISLE (LPC)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:CARLISLE
Last Name:BERMAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:BERMAN
Other - Last Name:CARLISLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:2300 COMMONWEALTH DR
Mailing Address - Street 2:#100
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-1893
Mailing Address - Country:US
Mailing Address - Phone:434-812-4009
Mailing Address - Fax:
Practice Address - Street 1:2300 COMMONWEALTH DR
Practice Address - Street 2:#100
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-1893
Practice Address - Country:US
Practice Address - Phone:434-812-4009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-05
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006917101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional