MEDICARE: MORGAN BERRY

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	103K00000X	Behavior Analyst

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700251980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MORGAN BERRY

Provider Business Mailing Address
First Line	:	4080 CALENDULA AVE
Second Line	:
City	:	TITUSVILLE
State	:	FL
Zip	:	32796-1887
Country	:	US
Telephone Number	:	321-506-9904
Fax Number	:

Provider Business Practice Location Address
First Line	:	1690 DAVIS DR
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32952-5933
Country	:	US
Telephone Number	:	855-832-6727
Fax Number	:

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

Provider Enumeration Date	:	12/14/2015
Last Update Date	:	01/09/2020

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Directions to “ MORGAN BERRY ” Practice Location

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