Provider Demographics
NPI:1629392717
Name:BERMEO, CARLOS ADRIAN (LCSW, NBCCH)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:ADRIAN
Last Name:BERMEO
Suffix:
Gender:M
Credentials:LCSW, NBCCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 COOPER ST FL 4
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08102-1155
Mailing Address - Country:US
Mailing Address - Phone:856-342-3040
Mailing Address - Fax:856-342-3049
Practice Address - Street 1:800 COOPER ST FL 4
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08102-1155
Practice Address - Country:US
Practice Address - Phone:856-342-3040
Practice Address - Fax:856-342-3049
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-18
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0183771041C0700X, 1041C0700X
NJ44SC056218001041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical