Licia Berry-Berard, MSW, Licsw LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

LICIA BERRY-BERARD, MSW, LICSW LLC

Practice address

321 Route 113
Thetford, VT 05054

Phone

(802) 565-0424

NPI assigned

Nov 3, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Licia Lane Berry-Berard, MSW, LICSWNPI 1225505381

Title

Owner

Phone

(802) 698-2246

Specialties & licenses 2

Addresses

Other names 1

• Licia Berry-Berard, MSW, LICSW LLC Former legal business name

Medicare fee-for-service enrollment

Enrolled in VT

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Licia Lane Berry-Berard, LICSW

  • Clinical Social Worker
  • North Thetford, VT
  • NPI 1225505381
  Medicare reassignment Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1698969600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704153600000",
    "number": "1124891809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 44",
            "city": "NORTH THETFORD",
            "state": "VT",
            "postal_code": "050540044",
            "telephone_number": "802-698-2246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "321 ROUTE 113",
            "city": "THETFORD",
            "state": "VT",
            "postal_code": "05054",
            "telephone_number": "802-565-0424"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "312 Clay Rd",
            "address_purpose": "LOCATION",
            "city": "North thetford",
            "state": "VT",
            "postal_code": "05054",
            "country_code": "US",
            "telephone_number": "802-698-2246",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LICIA BERRY-BERARD, MSW, LICSW LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-03",
        "last_updated": "2024-01-02",
        "certification_date": "2023-12-29",
        "status": "A",
        "authorized_official_last_name": "BERRY-BERARD",
        "authorized_official_first_name": "LICIA",
        "authorized_official_middle_name": "LANE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "802-698-2246",
        "authorized_official_credential": "MSW, LICSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Licia Berry-Berard, MSW, LICSW LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Licia Berry-Berard, MSW, LICSW LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• S Elise Bratcher Cushman, RD
• Little Rivers Health Care, Inc.
• Jordi Loaeza, LMT
• Jessica Beth Londa, PH.D.

• Community/Behavioral Health Agency in Thetford, VT
• Providers in Thetford, VT by specialty
• Community/Behavioral Health Agency in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.