Provider Demographics
NPI:1013073147
Name:BERMAN, ELLEN RAYNES (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:RAYNES
Last Name:BERMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 MACGREGOR DR
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-1409
Mailing Address - Country:US
Mailing Address - Phone:203-973-0181
Mailing Address - Fax:
Practice Address - Street 1:123 MACGREGOR DR
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-1409
Practice Address - Country:US
Practice Address - Phone:203-961-8818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001716103TC0700X
NY009609-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical