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General NPI Number Information
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NPI Number | 1659768083
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Entity Type | Organization
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Legal Business Name | LISA M. BERG, LCSW AND ASSOCIATES, LLC
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Dates
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Enumeration Date | 04/23/2015
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Last Update Date | 04/23/2015
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Provider Practice Location Address
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Address Line | 532 LAKE ST
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City | ANTIOCH
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State | IL
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Zip | 60002-1424
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Country | US
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Telephone | 224-357-6793
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Fax |
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Provider Business Mailing Address
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Address Line | 869 MOCKING BIRD DR
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City | ANTIOCH
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State | IL
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Zip | 60002-2726
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Country | US
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Telephone | 224-788-8156
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | MRS. LISA M BERG
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Credential | LCSW
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Telephone | 224-788-8156
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149007142
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License Number State | IL
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