Provider Demographics
NPI:1760461792
Name:BERRY, SCOTT H (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:H
Last Name:BERRY
Suffix:
Gender:M
Credentials:PSYD
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 197840
Mailing Address - Street 2:
Mailing Address - City:AGANA HEIGHTS
Mailing Address - State:GU
Mailing Address - Zip Code:96919-7840
Mailing Address - Country:US
Mailing Address - Phone:671-344-9401
Mailing Address - Fax:
Practice Address - Street 1:US NAVAL HOSPITAL GUAM
Practice Address - Street 2:BUILDING K-1
Practice Address - City:AGANA HEIGHTS
Practice Address - State:GU
Practice Address - Zip Code:96919-7840
Practice Address - Country:US
Practice Address - Phone:671-344-9401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD4058103T00000X
SC1253103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist