Provider Demographics
NPI:1114130382
Name:BERRY, STEPHEN D III (MA)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:D
Last Name:BERRY
Suffix:III
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 2 BOX 2198
Mailing Address - Street 2:
Mailing Address - City:SAYLORSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18353-9592
Mailing Address - Country:US
Mailing Address - Phone:570-620-9115
Mailing Address - Fax:
Practice Address - Street 1:3940 LOCUST LN
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-4023
Practice Address - Country:US
Practice Address - Phone:717-545-5787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health