Provider Demographics
NPI:1306236062
Name:BERRY-REICH, KAYLEE E (LICSW)
Entity type:Individual
Prefix:
First Name:KAYLEE
Middle Name:E
Last Name:BERRY-REICH
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4445 SE FIRMONT DR
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98367-9015
Mailing Address - Country:US
Mailing Address - Phone:360-535-3847
Mailing Address - Fax:877-682-9319
Practice Address - Street 1:4445 SE FIRMONT DR
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98367-9015
Practice Address - Country:US
Practice Address - Phone:360-535-3847
Practice Address - Fax:877-682-9319
Is Sole Proprietor?:No
Enumeration Date:2015-02-02
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW610242981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical