Healthcare Provider Details

I. General information

NPI: 1255584116
Provider Name (Legal Business Name): BERMAN INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2008
Last Update Date: 10/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 E ONTARIO ST STE 800
CHICAGO IL
60611-3279
US

IV. Provider business mailing address

211 E ONTARIO ST STE 800
CHICAGO IL
60611-3279
US

V. Phone/Fax

Practice location:
  • Phone: 312-255-8088
  • Fax:
Mailing address:
  • Phone: 312-255-8088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number149.010225
License Number StateIL

VIII. Authorized Official

Name: LAURA BERMAN
Title or Position: PSYCHOTHERAPIST/DIRECTOR
Credential: LCSW, PHD
Phone: 312-255-8088