Provider Demographics
NPI:1730390733
Name:BERMAN, MITCHELL M (MA)
Entity type:Individual
Prefix:MR
First Name:MITCHELL
Middle Name:M
Last Name:BERMAN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 1 BOX 50
Mailing Address - Street 2:
Mailing Address - City:KULA
Mailing Address - State:HI
Mailing Address - Zip Code:96790-9301
Mailing Address - Country:US
Mailing Address - Phone:808-878-3414
Mailing Address - Fax:808-878-6140
Practice Address - Street 1:HC 1 BOX 50
Practice Address - Street 2:
Practice Address - City:KULA
Practice Address - State:HI
Practice Address - Zip Code:96790-9301
Practice Address - Country:US
Practice Address - Phone:808-878-3414
Practice Address - Fax:808-878-6140
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMFT#9106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist