Provider Demographics
NPI:1578609483
Name:BERRY, HEATHER SANDRA (MSW LCSW)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:SANDRA
Last Name:BERRY
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1807
Mailing Address - Street 2:
Mailing Address - City:KERNVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93238
Mailing Address - Country:US
Mailing Address - Phone:760-417-2392
Mailing Address - Fax:760-376-3034
Practice Address - Street 1:6755 WOFFORD HEIGHTS
Practice Address - Street 2:SUITE E
Practice Address - City:WOFFORD HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:93285
Practice Address - Country:US
Practice Address - Phone:760-417-2392
Practice Address - Fax:760-376-3034
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS182321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical