Provider Demographics
NPI:1568457927
Name:BERRY, SHARON LEE (PHD, LP, ABPP)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:LEE
Last Name:BERRY
Suffix:
Gender:F
Credentials:PHD, LP, ABPP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2817 WEBSTER AVENUE SOUTH
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-1845
Mailing Address - Country:US
Mailing Address - Phone:612-916-5605
Mailing Address - Fax:651-855-2310
Practice Address - Street 1:BERRY PSYCHOLOGICAL SERVICES
Practice Address - Street 2:3340 REPUBLIC AVENUE, SUITE 120
Practice Address - City:ST. LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426-4154
Practice Address - Country:US
Practice Address - Phone:612-916-5605
Practice Address - Fax:612-813-8263
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNMN3625103TC2200X, 103TC0700X
MNLP3625103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN339214700Medicaid