Provider Demographics
NPI:1780095661
Name:BERMAN, MEGAN MARIE (LCPC)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:MARIE
Last Name:BERMAN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:MRS
Other - First Name:MEGAN
Other - Middle Name:MARIE
Other - Last Name:FORTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 MIRROR LAKE LN
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04856-6318
Mailing Address - Country:US
Mailing Address - Phone:207-576-3155
Mailing Address - Fax:
Practice Address - Street 1:1 MIRROR LAKE LN
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:ME
Practice Address - Zip Code:04856-6318
Practice Address - Country:US
Practice Address - Phone:207-576-3155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-14
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MECC4952101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health