Provider Demographics
NPI:1700804861
Name:BERRES, JOHN RAYNOND (LMSW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:RAYNOND
Last Name:BERRES
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2820 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:ESCANABA
Mailing Address - State:MI
Mailing Address - Zip Code:49829-9591
Mailing Address - Country:US
Mailing Address - Phone:902-786-6441
Mailing Address - Fax:906-233-1235
Practice Address - Street 1:2820 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829-9591
Practice Address - Country:US
Practice Address - Phone:902-786-6441
Practice Address - Fax:906-233-1235
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010839651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN21670030Medicare ID - Type Unspecified