Basic Information
| Provider Information | |||||||||
| NPI: | 1710036967 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BERRY | ||||||||
| FirstName: | CYNTHIA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | LPA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 327 1ST AVE NW | ||||||||
| Address2: | |||||||||
| City: | HICKORY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286016122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286955900 | ||||||||
| FaxNumber: | 8286954256 | ||||||||
| Practice Location | |||||||||
| Address1: | 301 E MEETING ST | ||||||||
| Address2: | |||||||||
| City: | MORGANTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28655 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286241900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2007 | ||||||||
| LastUpdateDate: | 08/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 0744 | NC | N | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103T00000X | 0744 | NC | Y | Behavioral Health & Social Service Providers | Psychologist |
ID Information
| ID | Type | State | Issuer | Description | 1421V | 01 | NC | BCBS | OTHER | NPI#1710036967 | 01 | NC | MEDCOST | OTHER | NPI#1710036967 | 01 | NC | DIRECT NET | OTHER | MIS #600494539 | 01 | NC | MAGELLAN | OTHER | 6107438 | 05 | NC | MEDICAID |