Provider Demographics
NPI:1023187192
Name:BERRY, ANDREW (PHD, PSYD, ABPP)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:BERRY
Suffix:
Gender:M
Credentials:PHD, PSYD, ABPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:632 PLANK RD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-4882
Mailing Address - Country:US
Mailing Address - Phone:518-587-4161
Mailing Address - Fax:
Practice Address - Street 1:632 PLANK ROAD
Practice Address - Street 2:SUITE 209
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-4882
Practice Address - Country:US
Practice Address - Phone:518-587-4161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017785103TC0700X
102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ300076708Medicare UPIN