Provider Demographics
NPI:1124015425
Name:BERMAN, LINDA SHERRY (PHD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:SHERRY
Last Name:BERMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21245 26TH AVE
Mailing Address - Street 2:SUITE 8A
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-1901
Mailing Address - Country:US
Mailing Address - Phone:718-229-7845
Mailing Address - Fax:718-229-6663
Practice Address - Street 1:21245 26TH AVE
Practice Address - Street 2:SUITE 8A
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11360-1901
Practice Address - Country:US
Practice Address - Phone:718-229-7845
Practice Address - Fax:718-229-6663
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-01
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008874-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY58444Medicare ID - Type Unspecified
NY514535Medicare UPIN