Healthcare Provider Details

I. General information

NPI: 1891090346
Provider Name (Legal Business Name): MARCUS PAUL BERLEY LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2011
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 KEITH AVE
CRANSTON RI
02910-5738
US

IV. Provider business mailing address

23 HILLSIDE AVE
PROVIDENCE RI
02906-2915
US

V. Phone/Fax

Practice location:
  • Phone: 206-698-2350
  • Fax:
Mailing address:
  • Phone: 206-698-2350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH 60643240
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC01416
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: