Healthcare Provider Details

I. General information

NPI: 1912913534
Provider Name (Legal Business Name): DONALD JOSEPH BERMONT PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 E MERRIMACK ST #23
LOWELL MA
01852-1251
US

IV. Provider business mailing address

5 ERIE AVE
NEWTON HIGHLANDS MA
02461-1513
US

V. Phone/Fax

Practice location:
  • Phone: 978-452-3711
  • Fax: 978-441-9351
Mailing address:
  • Phone: 617-964-4371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2448
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: