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NPI Code Detail

MEDICARE: REBECCA E BERRY LICDC, LSW

MEDICARE: REBECCA E BERRY LICDC, LSW
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
1101YA0400XAddiction (Substance Use Disorder) CounselorLICDC.162731OH

General Provider Information

NPI Number : 1639835812
Entity Type Code : Individual
Provider Name (Legal Business Name) : REBECCA E BERRY LICDC, LSW
Provider Business Mailing Address
First Line : 8380 PEARL RD APT 216
Second Line :
City : STRONGSVILLE
State : OH
Zip : 44136-1661
Country : US
Telephone Number : 216-212-0548
Fax Number :
Provider Business Practice Location Address
First Line : 13330 DETROIT AVE
Second Line :
City : LAKEWOOD
State : OH
Zip : 44107-2850
Country : US
Telephone Number : 440-821-5820
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/12/2021
Last Update Date : 06/16/2025

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