Individual
DR. STACEY M BERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
2801 N GANTENBEIN AVE, PORTLAND, OR 97227
(503) 276-8785
(503) 276-9241
Mailing address
PO BOX 4399, PORTLAND, OR 97208-4399
(503) 413-3900
(503) 413-3710
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
2993
OR
103TC0700X
Clinical Psychologist
2014033259
MO
Other
Enumeration date
09/17/2014
Last updated
08/15/2018
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