Provider Demographics
NPI:1639153703
Name:BERMAN, MARVIN HAROLD (PHD,CBT,BCIAC(EEG))
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:HAROLD
Last Name:BERMAN
Suffix:
Gender:M
Credentials:PHD,CBT,BCIAC(EEG)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 PLYMOUTH RD
Mailing Address - Street 2:STE. 111
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-1638
Mailing Address - Country:US
Mailing Address - Phone:610-940-0488
Mailing Address - Fax:215-359-0630
Practice Address - Street 1:521 PLYMOUTH RD
Practice Address - Street 2:SUITE 111
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1638
Practice Address - Country:US
Practice Address - Phone:610-940-0488
Practice Address - Fax:610-941-9912
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-006663-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA030270TA9Medicare PIN