Provider Demographics
NPI:1366834541
Name:BERRY, EULA YVONNE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:EULA
Middle Name:YVONNE
Last Name:BERRY
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:YVONNE
Other - Middle Name:
Other - Last Name:BERRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:8336 STRATHMORE PL
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63136-2542
Mailing Address - Country:US
Mailing Address - Phone:314-277-5385
Mailing Address - Fax:
Practice Address - Street 1:8336 STRATHMORE PL
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-2542
Practice Address - Country:US
Practice Address - Phone:314-277-5385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-25
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0041691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO004169Medicaid