Healthcare Provider Details

I. General information

NPI: 1760981567
Provider Name (Legal Business Name): TANYA BERCU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2018
Last Update Date: 10/28/2021
Certification Date: 10/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4031 W DAYTON ST
MCHENRY IL
60050-8377
US

IV. Provider business mailing address

1230 N HIGHLAND AVE
AURORA IL
60506-1401
US

V. Phone/Fax

Practice location:
  • Phone: 815-344-1230
  • Fax:
Mailing address:
  • Phone: 312-966-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: