Healthcare Provider Details

I. General information

NPI: 1760488555
Provider Name (Legal Business Name): PAULA A. BERRY PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/26/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

173 SEARS AVE STE 261
LOUISVILLE KY
40207-5062
US

IV. Provider business mailing address

173 SEARS AVE STE 261
LOUISVILLE KY
40207-5062
US

V. Phone/Fax

Practice location:
  • Phone: 502-899-7585
  • Fax: 502-899-7590
Mailing address:
  • Phone: 502-899-7585
  • Fax: 502-899-7590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number749
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: