Provider Demographics
NPI:1982182275
Name:BERRY, MADELINE ANNE (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:MADELINE
Middle Name:ANNE
Last Name:BERRY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:MADELINE
Other - Middle Name:ANNE
Other - Last Name:LIBRETTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:11511 NE 10TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-8578
Mailing Address - Country:US
Mailing Address - Phone:425-502-3000
Mailing Address - Fax:425-502-3589
Practice Address - Street 1:11511 NE 10TH ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-8578
Practice Address - Country:US
Practice Address - Phone:425-502-3000
Practice Address - Fax:425-502-3589
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-30
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA608658361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical