MEDICARE: ELLEN BERMAN,LCSW

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

General Provider Information

NPI Number	:	1790904373
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELLEN BERMAN,LCSW

Provider Business Mailing Address
First Line	:	2050 W COUNTY LINE RD
Second Line	:
City	:	JACKSON
State	:	NJ
Zip	:	08527-2014
Country	:	US
Telephone Number	:	732-370-5355
Fax Number	:

Provider Business Practice Location Address
First Line	:	2050 W COUNTY LINE RD
Second Line	:
City	:	JACKSON
State	:	NJ
Zip	:	08527-2014
Country	:	US
Telephone Number	:	732-370-5355
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST
Name	:	ELLEN L BERMAN
Credential	:	L.C.S.W
Telephone Number	:	732-370-5355

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	08/22/2020

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