Healthcare Provider Details

I. General information

NPI: 1831189323
Provider Name (Legal Business Name): JANICE SANDRA BERMAN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 DAMONMILL SQ SUITE 4A-1
CONCORD MA
01742-2858
US

IV. Provider business mailing address

9 DAMONMILL SQ SUITE 4A-1
CONCORD MA
01742-2858
US

V. Phone/Fax

Practice location:
  • Phone: 978-201-6065
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6773
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number6773
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: