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NPI Code Detail

MEDICARE: MANDI G BERMAN LCSW-C

MEDICARE: MANDI G BERMAN LCSW-C
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 Worker12919MD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
112919OTHERMDSTATE LICENSE

General Provider Information

NPI Number : 1518019256
Entity Type Code : Individual
Provider Name (Legal Business Name) : MANDI G BERMAN LCSW-C
Provider Business Mailing Address
First Line : 5 HARNESS CT
Second Line :
City : BALTIMORE
State : MD
Zip : 21208-6715
Country : US
Telephone Number : 410-602-2652
Fax Number :
Provider Business Practice Location Address
First Line : 3525 RESOURCE DR
Second Line :
City : RANDALLSTOWN
State : MD
Zip : 21133-4733
Country : US
Telephone Number : 410-922-1900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/16/2007
Last Update Date : 07/08/2007

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