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NPI Code Detail

MEDICARE: HEATHER BERRY CSW

MEDICARE: HEATHER BERRY CSW
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
11041C0700XClinical Social Worker255886KY

General Provider Information

NPI Number : 1205552247
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEATHER BERRY CSW
Provider Business Mailing Address
First Line : 328 DUKE RD APT 3
Second Line :
City : LEXINGTON
State : KY
Zip : 40502-2547
Country : US
Telephone Number : 303-845-0130
Fax Number :
Provider Business Practice Location Address
First Line : 1115 ASHGROVE RD
Second Line :
City : NICHOLASVILLE
State : KY
Zip : 40356-9202
Country : US
Telephone Number : 859-553-9755
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2022
Last Update Date : 10/12/2022

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Directions to “ HEATHER BERRY CSW” Practice Location

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