Provider Demographics
NPI:1265078828
Name:BERKEY, MARY (MA, BCBA, COBA)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
Last Name:BERKEY
Suffix:
Gender:F
Credentials:MA, BCBA, COBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5296 GARAND DR
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-7831
Mailing Address - Country:US
Mailing Address - Phone:419-261-1906
Mailing Address - Fax:
Practice Address - Street 1:3060 JOHNSTOWN UTICA RD
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:OH
Practice Address - Zip Code:43031-9394
Practice Address - Country:US
Practice Address - Phone:419-261-1906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-19
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH11937395103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst