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General NPI Number Information
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NPI Number | 1518346451
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Entity Type | Organization
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Legal Business Name | JANON BERRY
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Dates
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Enumeration Date | 05/26/2015
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Last Update Date | 05/26/2015
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Provider Practice Location Address
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Address Line | 457 VAN KIRK ST
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City | PHILADELPHIA
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State | PA
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Zip | 19120-1120
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Country | US
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Telephone | 570-763-9443
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Fax |
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Provider Business Mailing Address
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Address Line | 457 VAN KIRK ST
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City | PHILADELPHIA
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State | PA
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Zip | 19120-1120
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Country | US
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Telephone | 570-763-9443
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | DR. JANON BERRY
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Credential | LPC
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Telephone | 570-763-9443
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | PC006772
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 37PC00503200
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License Number State | NJ
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