=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710042403
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHAEL CRAIG BERMAN PSY.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/24/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1000 HERRONTOWN RD
-----------------------------------------------------
City | PRINCETON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08540-7716
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-273-3927
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 457 DUTCH NECK RD
-----------------------------------------------------
City | EAST WINDSOR
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08520-1215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-371-5835
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 35SI00394100
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------