Healthcare Provider Details

I. General information

NPI: 1376682328
Provider Name (Legal Business Name): DEANNA HOPE BERMAN ND,CM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 RACHEL CARSON WAY
ITHACA NY
14850-8402
US

IV. Provider business mailing address

206 RACHEL CARSON WAY
ITHACA NY
14850-8402
US

V. Phone/Fax

Practice location:
  • Phone: 607-351-7808
  • Fax: 844-478-9726
Mailing address:
  • Phone: 607-351-7808
  • Fax: 844-478-9726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number099.0099621
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberCM00195
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: