Healthcare Provider Details

I. General information

NPI: 1427028489
Provider Name (Legal Business Name): ELOISE J BERRY PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 03/08/2021
Certification Date: 03/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 S BRYN MAWR AVE STE 205
BRYN MAWR PA
19010-3216
US

IV. Provider business mailing address

14 S BRYN MAWR AVE STE 205
BRYN MAWR PA
19010-3216
US

V. Phone/Fax

Practice location:
  • Phone: 610-525-4828
  • Fax:
Mailing address:
  • Phone: 610-525-4828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number35SI00415300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberSI00415300
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPS-018232
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: