Provider Demographics
NPI:1831220946
Name:BERRY, BRENDA ALLEN (MSW)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:ALLEN
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 1:2525 HOLLY HALL ST
Mailing Address - Street 2:ROOM 200
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-4124
Mailing Address - Country:US
Mailing Address - Phone:713-566-6711
Mailing Address - Fax:713-440-1200
Practice Address - Street 1:1504 TAUB LOOP
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1608
Practice Address - Country:US
Practice Address - Phone:713-566-6711
Practice Address - Fax:713-440-1200
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX085221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8E0435Medicare ID - Type UnspecifiedMEDICARE NUMBER