Healthcare Provider Details

I. General information

NPI: 1831681246
Provider Name (Legal Business Name): SHELLI BERMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2018
Last Update Date: 06/16/2022
Certification Date: 06/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 SAINT PAUL ST STE 409
BALTIMORE MD
21202-2102
US

IV. Provider business mailing address

8512 ARBORWOOD RD
BALTIMORE MD
21208-1504
US

V. Phone/Fax

Practice location:
  • Phone: 443-449-5604
  • Fax:
Mailing address:
  • Phone: 443-226-7238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC10560
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: