Provider Demographics
NPI:1275932436
Name:BERRY, PATRICIA (LMHC)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:
Last Name:BERRY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:ANN
Other - Last Name:MAEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1243 CALLE INEZ
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-7193
Mailing Address - Country:US
Mailing Address - Phone:505-377-2680
Mailing Address - Fax:
Practice Address - Street 1:4001 OFFICE COURT DR
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-4929
Practice Address - Country:US
Practice Address - Phone:505-310-4764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-13
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health