Provider Demographics
NPI:1902473788
Name:MC BERRY, ERIN MICELLE (RD)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:MICELLE
Last Name:MC BERRY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:MICHELLE
Other - Last Name:MARTINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:CCI- HEALTH & WELLNESS
Mailing Address - Street 2:8630 FENTON STREET #1204
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910
Mailing Address - Country:US
Mailing Address - Phone:240-839-5811
Mailing Address - Fax:301-495-0318
Practice Address - Street 1:CCI- HEALTH & WELLNESS
Practice Address - Street 2:8630 FENTON STREET #1204
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910
Practice Address - Country:US
Practice Address - Phone:240-839-5811
Practice Address - Fax:301-495-0318
Is Sole Proprietor?:No
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX3540133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered