Provider Demographics
NPI:1710717699
Name:BERRY, MARJORIE ELLEN (LCSW)
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:ELLEN
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 1:821 ALAMANDA DR
Mailing Address - Street 2:
Mailing Address - City:NORTH PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-4139
Mailing Address - Country:US
Mailing Address - Phone:561-386-0833
Mailing Address - Fax:
Practice Address - Street 1:5220 HOOD RD STE 101
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33418-8910
Practice Address - Country:US
Practice Address - Phone:561-429-2397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW220791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty