1962581124 NPI number — MRS. SAUNDRA K BERRY LMFT, LCSW

Table of content: MRS. SAUNDRA K BERRY LMFT, LCSW (NPI 1962581124)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962581124 NPI number — MRS. SAUNDRA K BERRY LMFT, LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BERRY
Provider First Name:
SAUNDRA
Provider Middle Name:
K
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMFT, LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962581124
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7700 N MERIDIAN ST
Provider Second Line Business Mailing Address:
CFLM
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46260-3652
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-252-5518
Provider Business Mailing Address Fax Number:
317-259-5718

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7700 N MERIDIAN ST
Provider Second Line Business Practice Location Address:
CFLM
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46260-3652
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-252-5518
Provider Business Practice Location Address Fax Number:
317-259-5718
Provider Enumeration Date:
11/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  39001620A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 106H00000X , with the licence number: 35-001455 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000311557 . This is a "ANTHEM BCBS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 7766116 . This is a "AETNA" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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