Provider Demographics
NPI:1336106400
Name:BERRY, BARBARA (MSW, LCSW, LCAC)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:
Last Name:BERRY
Suffix:
Gender:F
Credentials:MSW, LCSW, LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 S.W. ARCHER ROAD
Mailing Address - Street 2:NORTH FLORIDA / SOUTH GEORGIA MALCOM RANDALL VA MEDICAL
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608
Mailing Address - Country:US
Mailing Address - Phone:352-548-1800
Mailing Address - Fax:352-548-1850
Practice Address - Street 1:1601 S.W. ARCHER ROAD
Practice Address - Street 2:NORTH FLORIDA / SOUTH GEORGIA MALCOM RANDALL VA MEDICAL
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608
Practice Address - Country:US
Practice Address - Phone:352-548-1800
Practice Address - Fax:352-548-1850
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN87000361A101YA0400X
101YM0800X
IN34005392A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health