Individual
JACQUELINE BERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AAHS
Contact information
Practice address
220 4TH AVE, RATON, NM 87740-2643
(575) 374-2032
(575) 374-0158
Mailing address
PO BOX 6952, TAOS, NM 87571-8094
(575) 758-5859
(575) 758-2832
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
NM
174400000X
Specialist
—
NM
Other
Enumeration date
01/04/2011
Last updated
01/04/2011
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