MEDICARE: MARJORIE ELLEN 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	SW22079	FL

General Provider Information

NPI Number	:	1710717699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARJORIE ELLEN BERRY LCSW

Provider Business Mailing Address
First Line	:	821 ALAMANDA DR
Second Line	:
City	:	NORTH PALM BEACH
State	:	FL
Zip	:	33408-4139
Country	:	US
Telephone Number	:	561-386-0833
Fax Number	:

Provider Business Practice Location Address
First Line	:	5220 HOOD RD STE 101
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33418-8910
Country	:	US
Telephone Number	:	561-429-2397
Fax Number	:

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

Provider Enumeration Date	:	08/05/2024
Last Update Date	:	08/05/2024

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