Healthcare Provider Details

I. General information

NPI: 1689117541
Provider Name (Legal Business Name): CARMEN N BERRY CDCA II
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2016
Last Update Date: 11/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 NORTHLAND BLVD
CINCINNATI OH
45240-3248
US

IV. Provider business mailing address

680 NORTHLAND BLVD
CINCINNATI OH
45240-3248
US

V. Phone/Fax

Practice location:
  • Phone: 513-941-4999
  • Fax:
Mailing address:
  • Phone: 513-941-4999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCDCA 150391
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: