MEDICARE: MS. SOCORRO E BERRY MFT

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	106H00000X	Marriage & Family Therapist	MFC15783	CA

General Provider Information

NPI Number	:	1912061490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SOCORRO E BERRY MFT

Provider Business Mailing Address
First Line	:	133 ANCHOR CT
Second Line	:
City	:	VALLEJO
State	:	CA
Zip	:	94591-7220
Country	:	US
Telephone Number	:	707-643-8015
Fax Number	:

Provider Business Practice Location Address
First Line	:	133 ANCHOR CT
Second Line	:
City	:	VALLEJO
State	:	CA
Zip	:	94591-7220
Country	:	US
Telephone Number	:	707-643-8015
Fax Number	:

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

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	06/14/2026

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