Provider Demographics
NPI:1740416072
Name:BERRIN, STACY (PHD)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:BERRIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:BERRIN
Other - Last Name:WASSERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1 TAYMIL RD
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10804-2801
Mailing Address - Country:US
Mailing Address - Phone:914-715-7038
Mailing Address - Fax:914-738-5105
Practice Address - Street 1:1 TAYMIL RD
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10804-2801
Practice Address - Country:US
Practice Address - Phone:914-715-7038
Practice Address - Fax:914-738-5105
Is Sole Proprietor?:No
Enumeration Date:2009-06-01
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY68 013708103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist