Provider Demographics
NPI:1881832129
Name:BERRY, SALLY ANN (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:SALLY
Middle Name:ANN
Last Name:BERRY
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 TAMARACK RD
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-2922
Mailing Address - Country:US
Mailing Address - Phone:609-865-6816
Mailing Address - Fax:
Practice Address - Street 1:15 TAMARACK RD
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-2922
Practice Address - Country:US
Practice Address - Phone:609-865-6816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-24
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0463582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry