Provider Demographics
NPI:1669736369
Name:BERMAN, CIVIA YENTY (MS,TSHH)
Entity type:Individual
Prefix:MRS
First Name:CIVIA
Middle Name:YENTY
Last Name:BERMAN
Suffix:
Gender:F
Credentials:MS,TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1413 E 12TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-6605
Mailing Address - Country:US
Mailing Address - Phone:347-410-3633
Mailing Address - Fax:
Practice Address - Street 1:1413 E 12TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-6605
Practice Address - Country:US
Practice Address - Phone:347-410-3633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-27
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist