Healthcare Provider Details

I. General information

NPI: 1063341634
Provider Name (Legal Business Name): KIRSTEN OLIVIA BERMAN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIRSTEN OLIVIA SPENCER LMSW

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 15TH ST
BROOKLYN NY
11215-4988
US

IV. Provider business mailing address

255 15TH ST
BROOKLYN NY
11215-4988
US

V. Phone/Fax

Practice location:
  • Phone: 718-788-5101
  • Fax:
Mailing address:
  • Phone: 718-788-5101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number108482
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: