Healthcare Provider Details

I. General information

NPI: 1982695995
Provider Name (Legal Business Name): ROBIN BERMAN LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 09/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5116 GRANDE DR NW
ALBUQUERQUE NM
87107-3308
US

IV. Provider business mailing address

5116 GRANDE DR NW
ALBUQUERQUE NM
87107-3308
US

V. Phone/Fax

Practice location:
  • Phone: 505-480-5414
  • Fax: 505-341-1268
Mailing address:
  • Phone: 505-480-5414
  • Fax: 505-321-1268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number36741
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0070651
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: