Provider Demographics
NPI:1871672188
Name:BERMAN, EMILY (LMHC)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:BERMAN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-1735
Mailing Address - Country:US
Mailing Address - Phone:857-998-1628
Mailing Address - Fax:
Practice Address - Street 1:3700 LYCKAN PKWY
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-2577
Practice Address - Country:US
Practice Address - Phone:919-381-6816
Practice Address - Fax:919-381-6818
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5875101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1303546Medicaid
MA221867Medicare Oscar/Certification
MAY10138Medicare ID - Type UnspecifiedMEDICARE PART B