Provider Demographics
NPI:1316554439
Name:BERRY, STUART (MSW, LISW)
Entity type:Individual
Prefix:
First Name:STUART
Middle Name:
Last Name:BERRY
Suffix:
Gender:M
Credentials:MSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 174
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:VT
Mailing Address - Zip Code:05730-0174
Mailing Address - Country:US
Mailing Address - Phone:740-272-3892
Mailing Address - Fax:
Practice Address - Street 1:18 YORKSHIRE RD
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-2846
Practice Address - Country:US
Practice Address - Phone:274-027-2389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.0000794-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical