Basic Information
| Provider Information | |||||||||
| NPI: | 1346290822 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BERMAN | ||||||||
| FirstName: | DEENA | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1156 N BROADWAY | ||||||||
| Address2: | ANDRUS CHILDREN'S CENTER | ||||||||
| City: | YONKERS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 107011108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9149653700 | ||||||||
| FaxNumber: | 9149653883 | ||||||||
| Practice Location | |||||||||
| Address1: | 50 DAYTON LN | ||||||||
| Address2: | ANDRUS CHILDREN'S CENTER MENTAL HEALTH DIVISION | ||||||||
| City: | PEEKSKILL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105662860 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9147363371 | ||||||||
| FaxNumber: | 9147363372 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2006 | ||||||||
| LastUpdateDate: | 12/18/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 020454 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 020454 | 01 | NY | NY LCSW LICENSE # | OTHER | 1285628552 | 01 | NY | JDAM NPI | OTHER | 00355940 | 01 | NY | AGENCY MEDICAID # | OTHER |