Provider Demographics
NPI:1245739622
Name:DEBERRY, KAREN (LSW)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:DEBERRY
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 BRYDEN RD., STE 122
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215
Mailing Address - Country:US
Mailing Address - Phone:614-681-0012
Mailing Address - Fax:614-412-6944
Practice Address - Street 1:700 BRYDEN RD., STE 122
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215
Practice Address - Country:US
Practice Address - Phone:614-681-0012
Practice Address - Fax:614-412-6944
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-12
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.0010120104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0275136Medicaid