Provider Demographics
NPI:1205139136
Name:BERRY, CHRISTOPHER TODD (MS)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:TODD
Last Name:BERRY
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4415 JOHNSON DAIRY RD APT 227
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-6774
Mailing Address - Country:US
Mailing Address - Phone:561-373-8307
Mailing Address - Fax:
Practice Address - Street 1:4415 JOHNSON DAIRY RD APT 227
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-6774
Practice Address - Country:US
Practice Address - Phone:561-373-8307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-15
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL802022717Medicaid