Provider Demographics
NPI:1407356892
Name:BERRY, SUSANNAH ROSE (LSW)
Entity type:Individual
Prefix:
First Name:SUSANNAH
Middle Name:ROSE
Last Name:BERRY
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 EDEN RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-4713
Mailing Address - Country:US
Mailing Address - Phone:717-462-7003
Mailing Address - Fax:717-459-6253
Practice Address - Street 1:825 EDEN RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-4713
Practice Address - Country:US
Practice Address - Phone:717-462-7003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-13
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor