Provider Demographics
NPI:1184149585
Name:BERMAN, ELENA A
Entity type:Individual
Prefix:MRS
First Name:ELENA
Middle Name:A
Last Name:BERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2654 BLUE HERON DR
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-1832
Mailing Address - Country:US
Mailing Address - Phone:330-348-4761
Mailing Address - Fax:
Practice Address - Street 1:2654 BLUE HERON DR
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236
Practice Address - Country:US
Practice Address - Phone:330-348-4761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant