Healthcare Provider Details

I. General information

NPI: 1629163092
Provider Name (Legal Business Name): JANETTA ELISHA BERRY-SISSOKO MSHR, LPC, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. JANETTA ELISHA BERRY

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 05/07/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 W 37TH ST FL 7
NEW YORK NY
10018-4289
US

IV. Provider business mailing address

320 W 37TH ST FL 7
NEW YORK NY
10018-4289
US

V. Phone/Fax

Practice location:
  • Phone: 800-287-1802
  • Fax:
Mailing address:
  • Phone: 800-287-1802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number85691
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number15805
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCP5791-R
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number61343410
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6303
License Number StateOK
# 6
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: