Provider Demographics
NPI:1700023710
Name:BERRILL, KEVIN THOMAS (LICSW)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:THOMAS
Last Name:BERRILL
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 CLYDESDALE PL NW
Mailing Address - Street 2:NO. 202
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-2180
Mailing Address - Country:US
Mailing Address - Phone:202-387-3435
Mailing Address - Fax:
Practice Address - Street 1:1860 CLYDESDALE PL NW
Practice Address - Street 2:NO. 202
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-2180
Practice Address - Country:US
Practice Address - Phone:202-387-3435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-13
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500786001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical