Provider Demographics
NPI:1699550285
Name:BERRY, KASIE (RBT)
Entity type:Individual
Prefix:
First Name:KASIE
Middle Name:
Last Name:BERRY
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 TURKEY LAKE RD STE 114
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-4205
Mailing Address - Country:US
Mailing Address - Phone:321-732-3723
Mailing Address - Fax:321-352-7168
Practice Address - Street 1:1505 BLANDING ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2906
Practice Address - Country:US
Practice Address - Phone:803-929-0011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-30
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician