Provider Demographics
NPI:1568844272
Name:CYNTHIA BERMAN, PH.D
Entity type:Organization
Organization Name:CYNTHIA BERMAN, PH.D
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:CAROLE
Authorized Official - Last Name:BERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PH,D
Authorized Official - Phone:707-869-0160
Mailing Address - Street 1:16330 WATSON RD
Mailing Address - Street 2:
Mailing Address - City:GUERNEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95446-8936
Mailing Address - Country:US
Mailing Address - Phone:707-869-0160
Mailing Address - Fax:
Practice Address - Street 1:16330 WATSON RD
Practice Address - Street 2:
Practice Address - City:GUERNEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95446-8936
Practice Address - Country:US
Practice Address - Phone:707-869-0160
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-18
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14305103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY14305OtherPSY14305