Provider Demographics
NPI:1508456468
Name:BERRY, AUBREY
Entity Type:Individual
Prefix:
First Name:AUBREY
Middle Name:
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 1:1313 CHEROKEE LN
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-4763
Mailing Address - Country:US
Mailing Address - Phone:443-243-4043
Mailing Address - Fax:
Practice Address - Street 1:11155 STRATFIELD CT
Practice Address - Street 2:
Practice Address - City:MARRIOTTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21104-1650
Practice Address - Country:US
Practice Address - Phone:410-970-2328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-24
Last Update Date:2021-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor