Provider Demographics
NPI:1265497648
Name:BERRY, JAN E (MSW)
Entity type:Individual
Prefix:MS
First Name:JAN
Middle Name:E
Last Name:BERRY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2045 WESTGATE DR
Mailing Address - Street 2:SUITE 304
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-7480
Mailing Address - Country:US
Mailing Address - Phone:610-865-8177
Mailing Address - Fax:610-865-2764
Practice Address - Street 1:2045 WESTGATE DR
Practice Address - Street 2:SUITE 304
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-7480
Practice Address - Country:US
Practice Address - Phone:610-865-8177
Practice Address - Fax:610-865-2764
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0148171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical