MEDICARE: DR. HEIDI BERMAN PHD, MFCC

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	106H00000X	Marriage & Family Therapist	MFC21381	CA

General Provider Information

NPI Number	:	1609182948
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HEIDI BERMAN PHD, MFCC

Provider Business Mailing Address
First Line	:	26081 MERIT CIR
Second Line	:	SUITE 120
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-7017
Country	:	US
Telephone Number	:	949-716-5150
Fax Number	:	949-716-5151

Provider Business Practice Location Address
First Line	:	26081 MERIT CIR
Second Line	:	SUITE 120
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-7017
Country	:	US
Telephone Number	:	949-716-5150
Fax Number	:	949-716-5151

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

Provider Enumeration Date	:	08/24/2010
Last Update Date	:	08/24/2010

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