Provider Demographics
NPI:1225253982
Name:BERLIN, JAN (PHD)
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:
Last Name:BERLIN
Suffix:
Gender:M
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:PO BOX 86
Mailing Address - Street 2:
Mailing Address - City:TOPANGA
Mailing Address - State:CA
Mailing Address - Zip Code:90290-0086
Mailing Address - Country:US
Mailing Address - Phone:310-395-7807
Mailing Address - Fax:310-455-0199
Practice Address - Street 1:20567 PARADISE LN
Practice Address - Street 2:
Practice Address - City:TOPANGA
Practice Address - State:CA
Practice Address - Zip Code:90290-3735
Practice Address - Country:US
Practice Address - Phone:310-395-7807
Practice Address - Fax:310-455-0199
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 6999103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist