Provider Demographics
NPI:1790913960
Name:BERRY, ASHLEY (PSYD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
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 1:3855 VIA NONA MARIE
Mailing Address - Street 2:STE. 304A
Mailing Address - City:CARMEL
Mailing Address - State:CA
Mailing Address - Zip Code:93923
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3855 VIA NONA MARIE
Practice Address - Street 2:STE. 304A
Practice Address - City:CARMEL
Practice Address - State:CA
Practice Address - Zip Code:93923
Practice Address - Country:US
Practice Address - Phone:805-861-4024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-26
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TC2200X
CAPSY28987103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent