Provider Demographics
NPI:1205552247
Name:BERRY, HEATHER (CSW)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:BERRY
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 DUKE RD APT 3
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-2547
Mailing Address - Country:US
Mailing Address - Phone:303-845-0130
Mailing Address - Fax:
Practice Address - Street 1:1115 ASHGROVE RD
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-9202
Practice Address - Country:US
Practice Address - Phone:859-553-9755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2558861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical