Provider Demographics
NPI:1588797096
Name:BERRIOS, AARON RANDOLPH (LCSW-R)
Entity Type:Individual
Prefix:MR
First Name:AARON
Middle Name:RANDOLPH
Last Name:BERRIOS
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-4504
Mailing Address - Country:US
Mailing Address - Phone:877-522-5034
Mailing Address - Fax:877-522-5034
Practice Address - Street 1:20 GREEN ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-4504
Practice Address - Country:US
Practice Address - Phone:877-522-5034
Practice Address - Fax:877-522-5034
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR054684-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical