Healthcare Provider Details

I. General information

NPI: 1538383534
Provider Name (Legal Business Name): JEROME R BERCIK LCSW LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 RIDGE ROAD
MUNSTER IN
46321
US

IV. Provider business mailing address

32 RIDGE ROAD
MUNSTER IN
46321
US

V. Phone/Fax

Practice location:
  • Phone: 219-836-8806
  • Fax: 219-836-8885
Mailing address:
  • Phone: 219-836-8806
  • Fax: 219-836-8885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number34001441A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number35000740A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: