Healthcare Provider Details

I. General information

NPI: 1144306515
Provider Name (Legal Business Name): DAVID T BERRY PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSYCHOLOGY 125 KASTLE HALL UNIVERSITY OF KENTUCKY
LEXINGTON KY
40506-0001
US

IV. Provider business mailing address

PSYCHOLOGY 125 KASTLE HALL UNIVERSITY OF KENTUCKY
LEXINGTON KY
40506-0001
US

V. Phone/Fax

Practice location:
  • Phone: 859-257-5451
  • Fax: 859-323-1979
Mailing address:
  • Phone: 859-257-5451
  • Fax: 859-323-1979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number619
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number619
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: