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General NPI Number Information
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NPI Number | 1144105255
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Entity Type | Individual
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Provider Name | JACOB COREY BERMAN
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Gender |
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Dates
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Enumeration Date | 08/07/2025
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Last Update Date | 08/07/2025
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Provider Practice Location Address
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Address Line | 3313 WASHINGTON ST
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City | JAMAICA PLAIN
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State | MA
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Zip | 02130-2691
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Country | US
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Telephone | 617-522-0650
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Fax |
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Provider Business Mailing Address
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Address Line | 135B CHISWICK RD
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City | BRIGHTON
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State | MA
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Zip | 02135-5331
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Country | US
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Telephone | 617-415-3920
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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