Healthcare Provider Details

I. General information

NPI: 1386951663
Provider Name (Legal Business Name): HOLLY CAREN BERMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2010
Last Update Date: 07/06/2022
Certification Date: 07/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6522 FREMONT AVE N
SEATTLE WA
98103-5358
US

IV. Provider business mailing address

192 ROSEHIP RD
EASTSOUND WA
98245-8957
US

V. Phone/Fax

Practice location:
  • Phone: 360-376-4700
  • Fax: 206-299-4449
Mailing address:
  • Phone: 360-376-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC00002889
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: