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General NPI Number Information
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NPI Number | 1639835812
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Entity Type | Individual
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Provider Name | REBECCA E BERRY LICDC, LSW
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Gender | Female
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Dates
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Enumeration Date | 11/12/2021
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Last Update Date | 06/16/2025
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Provider Practice Location Address
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Address Line | 13330 DETROIT AVE
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City | LAKEWOOD
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State | OH
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Zip | 44107-2850
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Country | US
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Telephone | 440-821-5820
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Fax |
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Provider Business Mailing Address
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Address Line | 8380 PEARL RD APT 216
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City | STRONGSVILLE
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State | OH
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Zip | 44136-1661
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Country | US
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Telephone | 216-212-0548
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LICDC.162731
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License Number State | OH
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