MEDICARE: DR. RACHEL ORIEL BERG PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	071.001556	IL

General Provider Information

NPI Number	:	1841417367
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RACHEL ORIEL BERG PH.D.

Provider Business Mailing Address
First Line	:	116 CORNWALL DR
Second Line	:
City	:	CRETE
State	:	IL
Zip	:	60417-1006
Country	:	US
Telephone Number	:	708-672-9000
Fax Number	:	708-672-9000

Provider Business Practice Location Address
First Line	:	116 CORNWALL DR
Second Line	:
City	:	CRETE
State	:	IL
Zip	:	60417-1006
Country	:	US
Telephone Number	:	708-672-9000
Fax Number	:	708-672-9000

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	07/08/2007

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