Provider Demographics
NPI:1790093961
Name:BERRY, PATRICE J (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PATRICE
Middle Name:J
Last Name:BERRY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 JEFFERSON DAVIS HWY
Mailing Address - Street 2:STE 202
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-8407
Mailing Address - Country:US
Mailing Address - Phone:540-300-7004
Mailing Address - Fax:
Practice Address - Street 1:615 JEFFERSON DAVIS HWY
Practice Address - Street 2:STE 202
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-8407
Practice Address - Country:US
Practice Address - Phone:540-300-7004
Practice Address - Fax:540-627-5094
Is Sole Proprietor?:No
Enumeration Date:2010-09-21
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004308103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1649506940Medicaid
VA200125300Medicaid