Provider Demographics
NPI:1659186153
Name:BERRY, JEAN E (LPC ICAADC)
Entity type:Individual
Prefix:MISS
First Name:JEAN
Middle Name:E
Last Name:BERRY
Suffix:
Gender:F
Credentials:LPC ICAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:PA
Mailing Address - Zip Code:16365-4013
Mailing Address - Country:US
Mailing Address - Phone:814-688-7891
Mailing Address - Fax:
Practice Address - Street 1:231 FRONT ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365-4013
Practice Address - Country:US
Practice Address - Phone:814-688-7891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-11
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC018003101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health