Provider Demographics
NPI:1417137159
Name:BERRY, JENNY (LICSW, MSW, MHP)
Entity Type:Individual
Prefix:MS
First Name:JENNY
Middle Name:
Last Name:BERRY
Suffix:
Gender:F
Credentials:LICSW, MSW, MHP
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:BERRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7500 OLD MILITARY RD NE STE 103
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98311-3242
Mailing Address - Country:US
Mailing Address - Phone:360-698-9258
Mailing Address - Fax:360-698-9296
Practice Address - Street 1:7500 OLD MILITARY RD NE STE 103
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98311-3242
Practice Address - Country:US
Practice Address - Phone:360-698-9258
Practice Address - Fax:360-698-9296
Is Sole Proprietor?:No
Enumeration Date:2007-11-09
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00057658101YP2500X
WALW 601895191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional