Healthcare Provider Details

I. General information

NPI: 1134806912
Provider Name (Legal Business Name): BRANDI JOY BERRY LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2023
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 STABLER ST RM 7
LANSING MI
48910-4567
US

IV. Provider business mailing address

PO BOX 30161
LANSING MI
48909-7661
US

V. Phone/Fax

Practice location:
  • Phone: 517-272-4104
  • Fax:
Mailing address:
  • Phone: 517-272-4104
  • Fax: 517-244-7174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6851098550
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: