Provider Demographics
NPI:1215693973
Name:BERRY, ISHAN (LPMHC)
Entity type:Individual
Prefix:
First Name:ISHAN
Middle Name:
Last Name:BERRY
Suffix:
Gender:F
Credentials:LPMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28338 CLAYTON ST
Mailing Address - Street 2:
Mailing Address - City:DAGSBORO
Mailing Address - State:DE
Mailing Address - Zip Code:19939-3853
Mailing Address - Country:US
Mailing Address - Phone:302-236-1253
Mailing Address - Fax:
Practice Address - Street 1:28338 CLAYTON ST
Practice Address - Street 2:
Practice Address - City:DAGSBORO
Practice Address - State:DE
Practice Address - Zip Code:19939-3853
Practice Address - Country:US
Practice Address - Phone:302-236-1253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health