Provider Demographics
NPI:1447368139
Name:BERMAN, LISA MYRA (PHD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:MYRA
Last Name:BERMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1503 SANTA ROSA RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229
Mailing Address - Country:US
Mailing Address - Phone:804-282-9100
Mailing Address - Fax:804-282-3266
Practice Address - Street 1:1503 SANTA ROSA RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229
Practice Address - Country:US
Practice Address - Phone:804-282-9100
Practice Address - Fax:804-282-3266
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001667103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7710026Medicaid
VA68001040Medicare ID - Type Unspecified
VA7710026Medicaid