Provider Demographics
NPI:1881060663
Name:BERRY, MOLLY
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:BERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:700 COMMERCE DR
Mailing Address - Street 2:290
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-9232
Mailing Address - Country:US
Mailing Address - Phone:651-714-3848
Mailing Address - Fax:
Practice Address - Street 1:700 COMMERCE DR
Practice Address - Street 2:290
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-9232
Practice Address - Country:US
Practice Address - Phone:651-714-3848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-17
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health