Provider Demographics
NPI:1427294115
Name:BERMAN, JASON S (PHD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:S
Last Name:BERMAN
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 1:1721 W PLANO PKWY STE 107
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-8633
Mailing Address - Country:US
Mailing Address - Phone:214-929-9244
Mailing Address - Fax:214-929-9244
Practice Address - Street 1:1721 W PLANO PKWY STE 107
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-8633
Practice Address - Country:US
Practice Address - Phone:214-929-9244
Practice Address - Fax:214-929-9244
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-30
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34212103TP2701X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
11987351OtherCAQH
TX34212OtherLICENSE