Provider Demographics
NPI:1710289095
Name:BERRY, PAULA JEAN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:PAULA
Middle Name:JEAN
Last Name:BERRY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3690 GRANT DR
Mailing Address - Street 2:SUITE K
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-5476
Mailing Address - Country:US
Mailing Address - Phone:775-351-7084
Mailing Address - Fax:
Practice Address - Street 1:3690 GRANT DR
Practice Address - Street 2:SUITE K
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-5476
Practice Address - Country:US
Practice Address - Phone:775-351-7084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-18
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4328-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical