Healthcare Provider Details

I. General information

NPI: 1760542328
Provider Name (Legal Business Name): KIMBERLY JOY BERMAN MSW LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540B WILLOW AVENUE
CEDARHURST NY
11516
US

IV. Provider business mailing address

1617 PLAINVIEW AVENUE
FAR ROCKAWAY NY
11691
US

V. Phone/Fax

Practice location:
  • Phone: 516-295-0550
  • Fax: 516-295-4646
Mailing address:
  • Phone: 718-327-1076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR0473831
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: