Provider Demographics
NPI:1770734972
Name:BERRY-HARRIS, TRACI AARON (PHD)
Entity type:Individual
Prefix:DR
First Name:TRACI
Middle Name:AARON
Last Name:BERRY-HARRIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 STEWARTSTOWN RD STE 200
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-3868
Mailing Address - Country:US
Mailing Address - Phone:304-598-2300
Mailing Address - Fax:304-598-2307
Practice Address - Street 1:1445 STEWARTSTOWN RD STE 200
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-3868
Practice Address - Country:US
Practice Address - Phone:304-598-2300
Practice Address - Fax:304-598-2307
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-06
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV971103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1Medicaid