Provider Demographics
NPI:1851458442
Name:BERDIE, MITCHELL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:
Last Name:BERDIE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1653 MONTANE DR E
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-8094
Mailing Address - Country:US
Mailing Address - Phone:303-358-0073
Mailing Address - Fax:720-316-6620
Practice Address - Street 1:1653 MONTANE DR E
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-8094
Practice Address - Country:US
Practice Address - Phone:303-358-0073
Practice Address - Fax:720-316-6620
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO845103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO7103153Medicaid
9441-6Medicare UPIN
CO9441-6Medicare ID - Type Unspecified