MEDICARE: MR. MARC ELLIOT BERMAN MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	102429	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	S021326	OTHER	MA	CHAMPIS

General Provider Information

NPI Number	:	1326035569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARC ELLIOT BERMAN MSW

Provider Business Mailing Address
First Line	:	PO BOX 326
Second Line	:
City	:	DOVER
State	:	MA
Zip	:	02030-0326
Country	:	US
Telephone Number	:	508-785-2319
Fax Number	:	508-785-3221

Provider Business Practice Location Address
First Line	:	30 SPRINGDALE AVE
Second Line	:
City	:	DOVER
State	:	MA
Zip	:	02030-2374
Country	:	US
Telephone Number	:	508-785-2319
Fax Number	:	508-785-3221

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2005
Last Update Date	:	07/08/2007

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