MEDICARE: ANGELA JAMENE BERRY MSW,LCSW-A

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	P019727	NC
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1619503380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA JAMENE BERRY MSW,LCSW-A

Provider Business Mailing Address
First Line	:	284 EXECUTIVE PARK DR STE 100
Second Line	:
City	:	CONCORD
State	:	NC
Zip	:	28025-1833
Country	:	US
Telephone Number	:	704-939-1100
Fax Number	:	704-939-1173

Provider Business Practice Location Address
First Line	:	701 E ROOSEVELT BLVD STE 600
Second Line	:
City	:	MONROE
State	:	NC
Zip	:	28112-4106
Country	:	US
Telephone Number	:	803-323-0186
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/13/2020
Last Update Date	:	10/13/2023

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