Provider Demographics
NPI:1730454307
Name:BERMAN, RALPH
Entity type:Individual
Prefix:
First Name:RALPH
Middle Name:
Last Name:BERMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 W. 8TH STREET
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731
Mailing Address - Country:US
Mailing Address - Phone:310-831-2358
Mailing Address - Fax:310-831-2356
Practice Address - Street 1:505 S PACIFIC AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-2656
Practice Address - Country:US
Practice Address - Phone:310-831-2358
Practice Address - Fax:310-831-2356
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-15
Last Update Date:2017-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB0809051024101YA0400X
CA1711135101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)