Provider Demographics
NPI:1801041173
Name:BERMAN, STACEY (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:
Last Name:BERMAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 GLENBROOK RD
Mailing Address - Street 2:
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952-1308
Mailing Address - Country:US
Mailing Address - Phone:845-216-4081
Mailing Address - Fax:845-362-5356
Practice Address - Street 1:17 GLENBROOK RD
Practice Address - Street 2:
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952-1308
Practice Address - Country:US
Practice Address - Phone:845-216-4081
Practice Address - Fax:845-362-5356
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-29
Last Update Date:2008-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN002770-1174400000X
NY002770-1174400000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No174400000XOther Service ProvidersSpecialist