Provider Demographics
NPI:1851079131
Name:MAYBERRY, KARIN ELIZABETH (PSYD)
Entity type:Individual
Prefix:DR
First Name:KARIN
Middle Name:ELIZABETH
Last Name:MAYBERRY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 EXECUTIVE DR STE 300
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:62208-1345
Mailing Address - Country:US
Mailing Address - Phone:618-688-4727
Mailing Address - Fax:618-688-7039
Practice Address - Street 1:8 EXECUTIVE DR STE 300
Practice Address - Street 2:
Practice Address - City:FAIRVIEW HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:62208-1345
Practice Address - Country:US
Practice Address - Phone:618-688-4727
Practice Address - Fax:618-688-7039
Is Sole Proprietor?:No
Enumeration Date:2023-07-07
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program