Provider Demographics
NPI:1588784029
Name:BERRY, MICHELE
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:BERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:MABRY
Other - Last Name:BERRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:6391 GABBERT RD
Mailing Address - Street 2:
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-1017
Mailing Address - Country:US
Mailing Address - Phone:805-552-0171
Mailing Address - Fax:805-552-0171
Practice Address - Street 1:165 E HIGH ST STE 102
Practice Address - Street 2:
Practice Address - City:MOORPARK
Practice Address - State:CA
Practice Address - Zip Code:93021-1151
Practice Address - Country:US
Practice Address - Phone:805-552-0171
Practice Address - Fax:805-552-0171
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS237201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical