Provider Demographics
NPI:1972342202
Name:BERRY, JAMILLAH T M (PHD, MSW)
Entity type:Individual
Prefix:DR
First Name:JAMILLAH
Middle Name:T M
Last Name:BERRY
Suffix:
Gender:F
Credentials:PHD, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 E MICHIGAN AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-5801
Mailing Address - Country:US
Mailing Address - Phone:734-288-8097
Mailing Address - Fax:
Practice Address - Street 1:1825 WOODBURY DR
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-4647
Practice Address - Country:US
Practice Address - Phone:313-775-1035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-24
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511177781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical