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General NPI Number Information
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NPI Number | 1568750230
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Entity Type | Individual
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Provider Name | MARIA BERMAN PH.D.
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Gender | Female
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Dates
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Enumeration Date | 07/15/2011
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 12636 SE STARK ST BLDG J
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City | PORTLAND
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State | OR
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Zip | 97233-1058
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Country | US
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Telephone | 503-253-4600
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Fax |
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Provider Business Mailing Address
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Address Line | 12636 SE STARK ST BLDG J
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City | PORTLAND
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State | OR
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Zip | 97233-1058
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Country | US
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Telephone | 503-253-4600
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Fax | 503-253-4609
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 2879
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 2879
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 27122
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 2879
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License Number State | OR
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Taxonomy #5
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2879
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License Number State | OR
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