Healthcare Provider Details

I. General information

NPI: 1992395859
Provider Name (Legal Business Name): EMILY BERKMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2021
Last Update Date: 01/24/2021
Certification Date: 01/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 N MICHIGAN AVE # 225
CHICAGO IL
60601-7511
US

IV. Provider business mailing address

5500 S UNIVERSITY AVE # 663
CHICAGO IL
60637-1522
US

V. Phone/Fax

Practice location:
  • Phone: 312-278-3054
  • Fax:
Mailing address:
  • Phone: 773-531-4588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number149.021065
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: