Healthcare Provider Details

I. General information

NPI: 1326035569
Provider Name (Legal Business Name): MARC ELLIOT BERMAN MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 SPRINGDALE AVE
DOVER MA
02030-2374
US

IV. Provider business mailing address

PO BOX 326
DOVER MA
02030-0326
US

V. Phone/Fax

Practice location:
  • Phone: 508-785-2319
  • Fax: 508-785-3221
Mailing address:
  • Phone: 508-785-2319
  • Fax: 508-785-3221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number102429
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: