Provider Demographics
NPI:1033943766
Name:BERMAN DE OELSNER, MIRTA (MHC)
Entity type:Individual
Prefix:
First Name:MIRTA
Middle Name:
Last Name:BERMAN DE OELSNER
Suffix:
Gender:F
Credentials:MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3420 72ND PL SE
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-3342
Mailing Address - Country:US
Mailing Address - Phone:206-914-2428
Mailing Address - Fax:
Practice Address - Street 1:3420 72ND PL SE
Practice Address - Street 2:
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-3342
Practice Address - Country:US
Practice Address - Phone:206-914-2428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60163854101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty