MEDICARE: SHARINE NICOLE BERRY M.A.

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	247200000X	Other Technician
2	106H00000X	Marriage & Family Therapist	4151001099	MI

General Provider Information

NPI Number	:	1558703272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARINE NICOLE BERRY M.A.

Provider Business Mailing Address
First Line	:	PO BOX 183053
Second Line	:
City	:	UTICA
State	:	MI
Zip	:	48318-3053
Country	:	US
Telephone Number	:	248-929-2207
Fax Number	:

Provider Business Practice Location Address
First Line	:	13854 LAKESIDE CIR
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48313-1443
Country	:	US
Telephone Number	:	248-403-5000
Fax Number	:

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

Provider Enumeration Date	:	07/23/2013
Last Update Date	:	06/02/2023

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