Provider Demographics
NPI:1881218873
Name:BERRY, MADELINE THERESE (LMFTA)
Entity Type:Individual
Prefix:MS
First Name:MADELINE
Middle Name:THERESE
Last Name:BERRY
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14022 102ND PL NE
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-5254
Mailing Address - Country:US
Mailing Address - Phone:425-205-0658
Mailing Address - Fax:
Practice Address - Street 1:15015 MAIN ST STE 210
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-5229
Practice Address - Country:US
Practice Address - Phone:425-800-6187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60976428106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist