Provider Demographics
NPI:1417427873
Name:BERRY, LOREN MICHELLE
Entity Type:Individual
Prefix:
First Name:LOREN
Middle Name:MICHELLE
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 1:8201 PETERS RD STE 1000
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3266
Mailing Address - Country:US
Mailing Address - Phone:561-404-1422
Mailing Address - Fax:
Practice Address - Street 1:8201 PETERS ROAD, SUITE 1000
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3332
Practice Address - Country:US
Practice Address - Phone:561-404-1422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-28
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist