Provider Demographics
NPI:1932266301
Name:BERRY, MARIJEAN (PHD, LICSW, LCSW-C)
Entity Type:Individual
Prefix:DR
First Name:MARIJEAN
Middle Name:
Last Name:BERRY
Suffix:
Gender:F
Credentials:PHD, LICSW, LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3120 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:CHEVERLY
Mailing Address - State:MD
Mailing Address - Zip Code:20785-1221
Mailing Address - Country:US
Mailing Address - Phone:301-322-3231
Mailing Address - Fax:
Practice Address - Street 1:1660 L ST NW
Practice Address - Street 2:SUITE 503
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-5603
Practice Address - Country:US
Practice Address - Phone:240-423-8765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC03011951041C0700X
MD049691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical