Provider Demographics
NPI:1194936328
Name:BERRY, LISA DAWN (CAADEI)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:DAWN
Last Name:BERRY
Suffix:
Gender:F
Credentials:CAADEI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 ARROWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95407-7503
Mailing Address - Country:US
Mailing Address - Phone:707-284-2950
Mailing Address - Fax:707-284-2955
Practice Address - Street 1:440 ARROWOOD DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95407-7503
Practice Address - Country:US
Practice Address - Phone:707-284-2950
Practice Address - Fax:707-284-2955
Is Sole Proprietor?:No
Enumeration Date:2007-05-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)