Provider Demographics
NPI:1780067439
Name:BERMAN, MARK (MA)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:BERMAN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12115 MAGNOLIA BLVD # 36
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91607-2609
Mailing Address - Country:US
Mailing Address - Phone:818-660-8515
Mailing Address - Fax:818-981-0649
Practice Address - Street 1:16250 VENTURA BLVD STE 465
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-4620
Practice Address - Country:US
Practice Address - Phone:818-660-8515
Practice Address - Fax:818-981-0649
Is Sole Proprietor?:No
Enumeration Date:2015-06-30
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF83015106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist