Provider Demographics
NPI:1124270947
Name:BERMAN, ADAM MATTHEW (PSYD)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:MATTHEW
Last Name:BERMAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8340 W FOND DU LAC AVE
Mailing Address - Street 2:BAYSHORE BILLING
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53218
Mailing Address - Country:US
Mailing Address - Phone:414-462-5773
Mailing Address - Fax:
Practice Address - Street 1:2901 W KINNICKINNIC RIVER PARKWAY
Practice Address - Street 2:STE 516 MEDICAL PSYCHOLOGY ASSOCIATION
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:54985
Practice Address - Country:US
Practice Address - Phone:920-235-4910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-13
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2762-57103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical