Provider Demographics
NPI:1699912998
Name:BERRYMAN, DAVID GLYN (LCSW)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:GLYN
Last Name:BERRYMAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1361 N HIGHWAY 89
Mailing Address - Street 2:UNIT 11
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025-2750
Mailing Address - Country:US
Mailing Address - Phone:801-725-5447
Mailing Address - Fax:
Practice Address - Street 1:1361 N HIGHWAY 89
Practice Address - Street 2:UNIT 11
Practice Address - City:FARMINGTON
Practice Address - State:UT
Practice Address - Zip Code:84025-2750
Practice Address - Country:US
Practice Address - Phone:801-725-5447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT338118-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical