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NPI Code Detail

MEDICARE: ELLEN BERMAN LCSW

MEDICARE: ELLEN BERMAN LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker44SC04310900NJ

General Provider Information

NPI Number : 1114005444
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELLEN BERMAN LCSW
Provider Business Mailing Address
First Line : 2290 W COUNTY LINE RD
Second Line : SUITE 206A
City : JACKSON
State : NJ
Zip : 08527-2267
Country : US
Telephone Number : 732-370-5355
Fax Number : 732-370-5344
Provider Business Practice Location Address
First Line : 2290 W COUNTY LINE RD
Second Line : SUITE 206A
City : JACKSON
State : NJ
Zip : 08527-2267
Country : US
Telephone Number : 732-370-5355
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2006
Last Update Date : 02/06/2015

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