Provider Demographics
NPI:1104199314
Name:BERRY, LINDA CAROL
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:CAROL
Last Name:BERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92-1728 KONA DR
Mailing Address - Street 2:
Mailing Address - City:OCEAN VIEW
Mailing Address - State:HI
Mailing Address - Zip Code:96704
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:92-1728 KONA DR
Practice Address - Street 2:
Practice Address - City:OCEAN VIEW
Practice Address - State:HI
Practice Address - Zip Code:96704
Practice Address - Country:US
Practice Address - Phone:808-961-5166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-17
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor