Provider Demographics
NPI:1144905704
Name:BERRY, DAVID SCOTT
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:SCOTT
Last Name:BERRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:695 W CROCKER LN
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOUSE
Mailing Address - State:CA
Mailing Address - Zip Code:95391-8801
Mailing Address - Country:US
Mailing Address - Phone:925-997-1039
Mailing Address - Fax:
Practice Address - Street 1:695 W CROCKER LN
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOUSE
Practice Address - State:CA
Practice Address - Zip Code:95391-8801
Practice Address - Country:US
Practice Address - Phone:925-997-1039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician