Provider Demographics
NPI:1013134766
Name:BERMAN, ROY WILLIAM (ACSW)
Entity Type:Individual
Prefix:MR
First Name:ROY
Middle Name:WILLIAM
Last Name:BERMAN
Suffix:
Gender:M
Credentials:ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 MOBREY LN
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-4236
Mailing Address - Country:US
Mailing Address - Phone:631-670-7368
Mailing Address - Fax:631-425-5954
Practice Address - Street 1:900 WALT WHITMAN RD
Practice Address - Street 2:SUITE LL7
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-2293
Practice Address - Country:US
Practice Address - Phone:631-425-1954
Practice Address - Fax:631-425-5954
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO17615101YA0400X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN00401Medicare ID - Type Unspecified