Provider Demographics
NPI:1538418587
Name:BERMACK, BRIAN CRAIG (PSYD)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:CRAIG
Last Name:BERMACK
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 WATER ST STE 5B
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02476-4807
Mailing Address - Country:US
Mailing Address - Phone:339-707-5236
Mailing Address - Fax:857-366-9688
Practice Address - Street 1:5 WATER ST STE 5B
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02476-4807
Practice Address - Country:US
Practice Address - Phone:339-707-5236
Practice Address - Fax:857-366-9688
Is Sole Proprietor?:No
Enumeration Date:2012-09-06
Last Update Date:2021-06-18
Deactivation Date:2021-04-09
Deactivation Code:
Reactivation Date:2021-06-18
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MA10403103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist