Provider Demographics
NPI:1639501570
Name:PAUL C. BERMAN & KATHERINE W. KILLEEN, PA
Entity Type:Organization
Organization Name:PAUL C. BERMAN & KATHERINE W. KILLEEN, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:C
Authorized Official - Last Name:BERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:410-337-8191
Mailing Address - Street 1:102 W PENNSYLVANIA AVE
Mailing Address - Street 2:SUITE 306
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-4526
Mailing Address - Country:US
Mailing Address - Phone:410-337-8191
Mailing Address - Fax:410-337-8192
Practice Address - Street 1:102 W PENNSYLVANIA AVE
Practice Address - Street 2:SUITE 306
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-4526
Practice Address - Country:US
Practice Address - Phone:410-337-8191
Practice Address - Fax:410-337-8192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-02
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2032103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty