Jerry Clifford Berry, CIT
Individual provider Active NPI Case Manager/Care Coordinator · Little Rock, AR
NPI 1972106706 · NPPES record last updated Nov 16, 2020
Key facts
- NPI
- 1972106706
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Case Manager/Care Coordinator 171M00000X
- License
- 100 (AR)
- Practice address
- 8404 Baseline Rd
Little Rock, AR 72209-4339 - Phone
- (501) 663-0708
- Fax
- (501) 313-4062
- NPI assigned
- Nov 16, 2020
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 100 | AR | MD | Addiction (Substance Use Disorder) Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Freshly Renewed Transitional | Current |
Accepting new patients |
Locations
8404 Baseline Rd
Little Rock, AR 72209
Phone (501) 663-0708
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | 100 | AR | Yes |
Addresses
Primary practice location
8404 Baseline Rd
Little Rock, AR 72209-4339
Mailing address
8404 Baseline Rd
Little Rock, AR 72209-4339
Phone (501) 663-0708
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100 | Other | AR | ASACB |
Other providers in Little Rock, AR
- Kellie L Berry-Hert
- Adam Berry
- Allison Berry
- Barbara Clarice Berry
- Elizabeth Berry
- Jonathan Thomas Berry
- Milly Anne Berry
- Robert Lyon Berry
- Tameka Rochell Berry
- Teresa Renee Berry
All providers in Little Rock, AR · Case Manager/Care Coordinator in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 16, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.