MEDICARE: KRISTINE SHARON BERRYMAN

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14115735	OTHER		CAQH

General Provider Information

NPI Number	:	1851801484
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINE SHARON BERRYMAN

Provider Business Mailing Address
First Line	:	640 E MICHIGAN ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-0008
Country	:	US
Telephone Number	:	317-220-7081
Fax Number	:

Provider Business Practice Location Address
First Line	:	7037 ROLLING HILLS DR
Second Line	:
City	:	HUDSONVILLE
State	:	MI
Zip	:	49426-8760
Country	:	US
Telephone Number	:	317-931-5166
Fax Number	:

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

Provider Enumeration Date	:	10/10/2017
Last Update Date	:	11/11/2022

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