MEDICARE: MADISON RENEE BERRY LCSW

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	1041C0700X	Clinical Social Worker	67090	TX

General Provider Information

NPI Number	:	1528886025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADISON RENEE BERRY LCSW

Provider Business Mailing Address
First Line	:	PO BOX 1226
Second Line	:
City	:	KYLE
State	:	TX
Zip	:	78640-1226
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	645 FM 967 STE 104
Second Line	:
City	:	BUDA
State	:	TX
Zip	:	78610-4747
Country	:	US
Telephone Number	:	512-710-7965
Fax Number	:

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

Provider Enumeration Date	:	10/02/2024
Last Update Date	:	01/08/2026

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