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NPI Code Detail

MEDICARE: COURTNEY BERRY LSGW

MEDICARE:   COURTNEY  BERRY  LSGW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator
21041C0700XClinical Social Worker
3104100000XSocial Worker

General Provider Information

NPI Number : 1205457512
Entity Type Code : Individual
Provider Name (Legal Business Name) : COURTNEY BERRY LSGW
Provider Business Mailing Address
First Line : 6031 N HIL MAR CIR
Second Line :
City : DISTRICT HEIGHTS
State : MD
Zip : 20747-2962
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6031 N HIL MAR CIR
Second Line :
City : DISTRICT HEIGHTS
State : MD
Zip : 20747-2962
Country : US
Telephone Number : 240-281-2283
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/28/2020
Last Update Date : 03/06/2024

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