Provider Demographics
NPI:1588781462
Name:BERMAN, JUDITH CLAIRE (MA)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:CLAIRE
Last Name:BERMAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:S
Other - Last Name:BERMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:1015 CHESTNUT ST
Mailing Address - Street 2:STE 901
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4309
Mailing Address - Country:US
Mailing Address - Phone:215-592-0139
Mailing Address - Fax:215-592-1675
Practice Address - Street 1:1015 CHESTNUT ST
Practice Address - Street 2:STE 901
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4309
Practice Address - Country:US
Practice Address - Phone:215-592-0139
Practice Address - Fax:215-592-1675
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS001774L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
2101414OtherCIGNA
NG6821OtherEMPIRE BLUE CROSS
PA0043755000OtherINDEPENDENCE BLUE CROSS
5599676OtherAETNA