Healthcare Provider Details

I. General information

NPI: 1083087738
Provider Name (Legal Business Name): MRS. MARCI BERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2015
Last Update Date: 08/09/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44359 PALM ST
INDIO CA
92201-3116
US

IV. Provider business mailing address

44374 PALM ST
INDIO CA
92201-3117
US

V. Phone/Fax

Practice location:
  • Phone: 310-779-1947
  • Fax:
Mailing address:
  • Phone: 310-779-9147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: