Provider Demographics
NPI:1801186424
Name:BERRY, ONDRA
Entity Type:Individual
Prefix:
First Name:ONDRA
Middle Name:
Last Name:BERRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 KEYSTONE AVE
Mailing Address - Street 2:304
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-5577
Mailing Address - Country:US
Mailing Address - Phone:775-333-5222
Mailing Address - Fax:775-333-5221
Practice Address - Street 1:63 KEYSTONE AVE
Practice Address - Street 2:304
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-5577
Practice Address - Country:US
Practice Address - Phone:775-333-5222
Practice Address - Fax:775-333-5221
Is Sole Proprietor?:No
Enumeration Date:2011-04-15
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst