Provider Demographics
NPI:1922607746
Name:BERRY, ABENA (PSYD)
Entity Type:Individual
Prefix:
First Name:ABENA
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 1:5550 TOUHY AVE STE 404
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-3227
Mailing Address - Country:US
Mailing Address - Phone:847-329-9210
Mailing Address - Fax:
Practice Address - Street 1:5550 TOUHY AVE STE 404
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-3227
Practice Address - Country:US
Practice Address - Phone:847-329-9210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-22
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.010361103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical