MEDICARE: LARISA BERMAN MS CCC-SLP

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	235Z00000X	Speech-Language Pathologist	003050	CT

General Provider Information

NPI Number	:	1801895503
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARISA BERMAN MS CCC-SLP

Provider Business Mailing Address
First Line	:	1400 BEDFORD ST
Second Line	:	ST #2
City	:	STAMFORD
State	:	CT
Zip	:	06905-5200
Country	:	US
Telephone Number	:	203-569-3848
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 BEDFORD ST
Second Line	:	ST #2
City	:	STAMFORD
State	:	CT
Zip	:	06905-5200
Country	:	US
Telephone Number	:	203-569-3848
Fax Number	:

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

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	08/17/2016

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Directions to “ LARISA BERMAN MS CCC-SLP” Practice Location

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