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General NPI Number Information
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NPI Number | 1962390435
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Entity Type | Individual
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Provider Name | KEISHA NICOLE BERRY
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Gender | Female
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Dates
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Enumeration Date | 06/25/2025
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Last Update Date | 06/25/2025
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Provider Practice Location Address
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Address Line | 300 FREDERICK ST STE 3
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City | HANOVER
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State | PA
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Zip | 17331-3709
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Country | US
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Telephone | 717-969-2894
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Fax |
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Provider Business Mailing Address
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Address Line | 325 BROOKLYN AVE
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City | YORK
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State | PA
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Zip | 17401-3806
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Country | US
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Telephone | 717-779-5898
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Fax | 717-779-5898
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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 | 10130
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License Number State | PA
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