1255479648 NPI number — MS. CARYN P. BERMAN M.ED MSW LICSW

Table of content: MS. CARYN P. BERMAN M.ED MSW LICSW (NPI 1255479648)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255479648 NPI number — MS. CARYN P. BERMAN M.ED MSW LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BERMAN
Provider First Name:
CARYN
Provider Middle Name:
P.
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.ED MSW LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BLAYER
Provider Other First Name:
CARYN
Provider Other Middle Name:
P.
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.ED MSW LICSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1255479648
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15 LUCIA RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARBLEHEAD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01945-2018
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-631-3029
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 LUCIA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARBLEHEAD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01945-2018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-631-3029
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  113922 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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