Healthcare Provider Details

I. General information

NPI: 1578609483
Provider Name (Legal Business Name): HEATHER SANDRA BERRY MSW LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6755 WOFFORD HEIGHTS SUITE E
WOFFORD HEIGHTS CA
93285
US

IV. Provider business mailing address

PO BOX 1807
KERNVILLE CA
93238
US

V. Phone/Fax

Practice location:
  • Phone: 760-417-2392
  • Fax: 760-376-3034
Mailing address:
  • Phone: 760-417-2392
  • Fax: 760-376-3034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS18232
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: