Healthcare Provider Details

I. General information

NPI: 1811877525
Provider Name (Legal Business Name): MATTHEW LUIS BERRY LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2025
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6620 VIA DEL ORO
SAN JOSE CA
95119-1452
US

IV. Provider business mailing address

1001 HARVEY DR APT 128
WALNUT CREEK CA
94597-3601
US

V. Phone/Fax

Practice location:
  • Phone: 408-360-2300
  • Fax:
Mailing address:
  • Phone: 209-395-7716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number19617
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: