Provider Demographics
NPI:1801895503
Name:BERMAN, LARISA (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:LARISA
Middle Name:
Last Name:BERMAN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 BEDFORD ST
Mailing Address - Street 2:ST #2
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-5200
Mailing Address - Country:US
Mailing Address - Phone:203-569-3848
Mailing Address - Fax:
Practice Address - Street 1:1400 BEDFORD ST
Practice Address - Street 2:ST #2
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5200
Practice Address - Country:US
Practice Address - Phone:203-569-3848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003050235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist