MEDICARE: ISHAN BERRY LPMHC

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
1	101YM0800X	Mental Health Counselor		DE
2	101YP2500X	Professional Counselor	0701014090	VA

General Provider Information

NPI Number	:	1215693973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISHAN BERRY LPMHC

Provider Business Mailing Address
First Line	:	400 LAURA LN
Second Line	:
City	:	MIDDLETOWN
State	:	DE
Zip	:	19709-9107
Country	:	US
Telephone Number	:	302-236-1253
Fax Number	:

Provider Business Practice Location Address
First Line	:	28338 CLAYTON ST
Second Line	:
City	:	DAGSBORO
State	:	DE
Zip	:	19939-3853
Country	:	US
Telephone Number	:	302-236-1253
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2021
Last Update Date	:	05/20/2026

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