Healthcare Provider Details

I. General information

NPI: 1154420214
Provider Name (Legal Business Name): FELICIA L BERRY-MITCHELL PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: FELICIA L. BERRY PHD

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 CA-104
IONE CA
95640
US

IV. Provider business mailing address

1559B SLOAT BLVD
SAN FRANCISCO CA
94132-1222
US

V. Phone/Fax

Practice location:
  • Phone: 415-547-0764
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number36757
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number025430
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY003237
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: