Healthcare Provider Details

I. General information

NPI: 1710108485
Provider Name (Legal Business Name): LINDA J BERRY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

787 N. MICHIGAN AVE., #1
PASADENA CA
91104
US

IV. Provider business mailing address

787 N. MICHIGAN AVE., #1
PASADENA CA
91104
US

V. Phone/Fax

Practice location:
  • Phone: 626-353-7860
  • Fax:
Mailing address:
  • Phone: 626-353-7860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS17624
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: