Provider Demographics
NPI:1770629719
Name:BERMAN, CAROL FEINFIELD (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:FEINFIELD
Last Name:BERMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:CAROL
Other - Middle Name:ANNE
Other - Last Name:FEINFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:SOQUEL
Mailing Address - State:CA
Mailing Address - Zip Code:95073-2956
Mailing Address - Country:US
Mailing Address - Phone:831-462-5282
Mailing Address - Fax:831-462-0388
Practice Address - Street 1:3121 PARK AVE
Practice Address - Street 2:SUITE I
Practice Address - City:SOQUEL
Practice Address - State:CA
Practice Address - Zip Code:95073-2956
Practice Address - Country:US
Practice Address - Phone:831-462-5282
Practice Address - Fax:831-462-0388
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS106651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ00380ZMedicare ID - Type Unspecified