Healthcare Provider Details

I. General information

NPI: 1336756410
Provider Name (Legal Business Name): LUZ B BERNAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2020
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1580 N NORTHWEST HWY STE 116
PARK RIDGE IL
60068-1470
US

IV. Provider business mailing address

1580 N NORTHWEST HWY STE 116
PARK RIDGE IL
60068-1470
US

V. Phone/Fax

Practice location:
  • Phone: 847-975-5128
  • Fax:
Mailing address:
  • Phone: 847-975-5128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149026500
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: