Healthcare Provider Details

I. General information

NPI: 1649772005
Provider Name (Legal Business Name): SHARON MARIE BERLIN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2018
Last Update Date: 09/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 WILLOW RD
WINNETKA IL
60093-3870
US

IV. Provider business mailing address

750 WILLOW RD
WINNETKA IL
60093-3870
US

V. Phone/Fax

Practice location:
  • Phone: 224-330-5835
  • Fax:
Mailing address:
  • Phone: 224-330-5835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.015805
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.020577
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: