Healthcare Provider Details

I. General information

NPI: 1013030741
Provider Name (Legal Business Name): ELIZABETH KOROPSAK-BERMAN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 11/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 HOLMES DL
ALBANY NY
12203-2022
US

IV. Provider business mailing address

45 HOLMES DL
ALBANY NY
12203-2022
US

V. Phone/Fax

Practice location:
  • Phone: 518-487-4208
  • Fax:
Mailing address:
  • Phone: 518-487-4208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number020039
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: