=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124233804
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CARLA J BERRY RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/14/2007
-----------------------------------------------------
Last Update Date | 03/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 165 E PARK AVE
-----------------------------------------------------
City | NILES
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44446-2352
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-544-8005
-----------------------------------------------------
Fax | 330-544-9379
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10262 MYERS RD
-----------------------------------------------------
City | KENSINGTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44427-9726
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-704-8513
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WP0807X
-----------------------------------------------------
Taxonomy Name | Child & Adolescent Psychiatric/Mental Health Registered Nurse
-----------------------------------------------------
License Number | 186871
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163WP0807X
-----------------------------------------------------
Taxonomy Name | Child & Adolescent Psychiatric/Mental Health Registered Nurse
-----------------------------------------------------
License Number | RN.186871
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------