Provider Demographics
NPI:1922782465
Name:BERRY, ANTHONY D SR
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:D
Last Name:BERRY
Suffix:SR
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:ANTHONY
Other - Middle Name:DARNELL
Other - Last Name:BERRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2319 SAINT MATTHEWS RD
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29118-2042
Mailing Address - Country:US
Mailing Address - Phone:803-536-1571
Mailing Address - Fax:
Practice Address - Street 1:2319 SAINT MATTHEWS RD
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118-2042
Practice Address - Country:US
Practice Address - Phone:803-747-0364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health