Provider Demographics
NPI:1053479493
Name:BERRY, SUSAN PERCITA (CAADE)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:PERCITA
Last Name:BERRY
Suffix:
Gender:F
Credentials:CAADE
Other - Prefix:MRS
Other - First Name:SUE
Other - Middle Name:P
Other - Last Name:BERRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CAADE
Mailing Address - Street 1:592 RIO LINDO AVE
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-1817
Mailing Address - Country:US
Mailing Address - Phone:530-891-2951
Mailing Address - Fax:530-895-6547
Practice Address - Street 1:592 RIO LINDO AVENUE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926
Practice Address - Country:US
Practice Address - Phone:530-891-2775
Practice Address - Fax:530-895-6547
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
990328101YA0400X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical