Kelly Marie Berry, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C014506 Issued in NC

Practice address

3551 Roger Brooke Dr
Jbsa Ft Sam Houston, TX 78234-4504

Phone

(210) 916-4141

NPI assigned

Jul 3, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Radiology Associates of Southwest Louisiana

  • Diagnostic Radiology Physician
  • Alexandria, LA
  • NPI 1033215710
  NPD (past)

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

{
    "created_epoch": "1530576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722816000000",
    "number": "1306332234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 WILFORD HALL LOOP BLDG 4554",
            "city": "JBSA LACKLAND",
            "state": "TX",
            "postal_code": "782365638"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3551 ROGER BROOKE DR",
            "city": "JBSA FT SAM HOUSTON",
            "state": "TX",
            "postal_code": "782344504",
            "telephone_number": "210-916-4141"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "803 S Walker St",
            "address_purpose": "LOCATION",
            "city": "Burgaw",
            "state": "NC",
            "postal_code": "284255001",
            "country_code": "US",
            "telephone_number": "910-259-0668",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "120 Coastal Horizons Dr",
            "address_purpose": "LOCATION",
            "city": "Shallotte",
            "state": "NC",
            "postal_code": "284706094",
            "country_code": "US",
            "telephone_number": "910-754-4515",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1100 Wilford Hall Loop Bldg 4554",
            "address_purpose": "LOCATION",
            "city": "Jbsa Lackland",
            "state": "TX",
            "postal_code": "782365638",
            "country_code": "US",
            "telephone_number": "210-292-7412",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BERRY",
        "first_name": "KELLY",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-03",
        "last_updated": "2024-08-05",
        "certification_date": "2024-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C014506",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "P012306",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrew Bayne, MD
• Darrick James Beckman, M.D.
• Raymond Thomas Beckman, PSY.D.
• Koree Begovic, MD
• Nicolas Busingye Beraho, MD
• Braydan David Bezzant
• Kimberlie A. Biever, ANP-BC, ACNP-BC,CCNS
• Alexander Brooks Black, M.D.
• Elizabeth Mara Blalock, MD
• Sandra Boettcher, MD

• Clinical Social Worker in Jbsa Ft Sam Houston, TX
• Providers in Jbsa Ft Sam Houston, TX by specialty
• Clinical Social Worker in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.