Provider Demographics
NPI:1356414866
Name:BERMAN, PATRICIA (LCSW)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:
Last Name:BERMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 NW 6TH ST
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-4812
Mailing Address - Country:US
Mailing Address - Phone:541-754-1209
Mailing Address - Fax:541-754-0477
Practice Address - Street 1:216 NW 6TH ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-4812
Practice Address - Country:US
Practice Address - Phone:541-754-1209
Practice Address - Fax:541-754-0477
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR05211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0000TLCSVMedicare ID - Type UnspecifiedMEDICARE
OR048229000Medicare UPIN