Provider Demographics
NPI:1912706177
Name:BERMAN, MITCHELL ERIC (PHD)
Entity type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:ERIC
Last Name:BERMAN
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:393 A Q STANLEY RD
Mailing Address - Street 2:
Mailing Address - City:CALEDONIA
Mailing Address - State:MS
Mailing Address - Zip Code:39740-7558
Mailing Address - Country:US
Mailing Address - Phone:601-794-7664
Mailing Address - Fax:
Practice Address - Street 1:180 MAGRUDER STREET
Practice Address - Street 2:RICE HALL
Practice Address - City:MISSISSIPPI STATE
Practice Address - State:MS
Practice Address - Zip Code:39762
Practice Address - Country:US
Practice Address - Phone:662-325-3202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS36-599103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist