Provider Demographics
NPI:1841313186
Name:BERRY, NORMA JEAN (LCSW)
Entity type:Individual
Prefix:MS
First Name:NORMA
Middle Name:JEAN
Last Name:BERRY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8920 TRAILRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-5210
Mailing Address - Country:US
Mailing Address - Phone:254-743-0963
Mailing Address - Fax:254-743-0137
Practice Address - Street 1:8920 TRAILRIDGE DR
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-5210
Practice Address - Country:US
Practice Address - Phone:254-743-0963
Practice Address - Fax:254-743-0137
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX93711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical