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General NPI Number Information
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NPI Number | 1902024052
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Entity Type | Organization
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Legal Business Name | SUSAN D. BERRY, MA, LMHC, P.A.
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 30 N GROVE ST SUITE C
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City | MERRITT ISLAND
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State | FL
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Zip | 32953-3530
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Country | US
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Telephone | 321-863-0599
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Fax |
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Provider Business Mailing Address
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Address Line | 30 N GROVE ST SUITE C
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City | MERRITT ISLAND
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State | FL
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Zip | 32953-3530
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Country | US
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Telephone | 321-863-0599
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Fax |
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Authorized Official
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Title or Position | PRESIDENT, DIRECTOR
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Name | SUSAN D. BERRY
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Credential | LMHC
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Telephone | 321-863-0599
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | MH7592
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License Number State | FL
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