Provider Demographics
NPI:1952170557
Name:BERRYMAN, ANTHONY WILLIAM (LCSW)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:WILLIAM
Last Name:BERRYMAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11312 HASKELL AVE
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-3946
Mailing Address - Country:US
Mailing Address - Phone:213-364-3610
Mailing Address - Fax:
Practice Address - Street 1:11312 HASKELL AVE
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-3946
Practice Address - Country:US
Practice Address - Phone:213-364-3610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-22
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW278571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical