MEDICARE: BETH M. BERMAN PSY.D. PC

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	103T00000X	Psychologist	6301010600	MI

General Provider Information

NPI Number	:	1952539025
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BETH M. BERMAN PSY.D. PC

Provider Business Mailing Address
First Line	:	7112 BRANFORD CT
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-1083
Country	:	US
Telephone Number	:	248-505-8324
Fax Number	:	248-926-2012

Provider Business Practice Location Address
First Line	:	425 W HURON ST
Second Line	:	SUITE 210
City	:	MILFORD
State	:	MI
Zip	:	48381-2242
Country	:	US
Telephone Number	:	248-505-8324
Fax Number	:	248-926-2012

Authorized Official
Title or Position	:	PRESEIDENT
Name	:	DR. BETH M BERMAN
Credential	:	PSY.D.
Telephone Number	:	248-505-8324

Provider Enumeration Date	:	06/29/2009
Last Update Date	:	06/29/2009

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