Provider Demographics
NPI:1790290518
Name:BERRY, LISA (LICSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:BERRY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 HICKS WAY, TOBIN 123
Mailing Address - Street 2:PSYCHOLOGICAL SERVICES CENTER, UNIVERSITY OF MASSACHUSE
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01003-9271
Mailing Address - Country:US
Mailing Address - Phone:413-545-0042
Mailing Address - Fax:413-577-0947
Practice Address - Street 1:135 HICKS WAY, TOBIN 123
Practice Address - Street 2:PSYCHOLOGICAL SERVICES CENTER, UNIVERSITY OF MASSACHUSE
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01003-9271
Practice Address - Country:US
Practice Address - Phone:413-545-0042
Practice Address - Fax:413-577-0947
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-04
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1106191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical