Provider Demographics
NPI:1497721807
Name:BERKHEIMER, KELLY (PSYD)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:BERKHEIMER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:NIRENBERG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1332 N HALSTED ST STE 306
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-2691
Mailing Address - Country:US
Mailing Address - Phone:773-744-3538
Mailing Address - Fax:
Practice Address - Street 1:1332 N HALSTED ST STE 306
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-2691
Practice Address - Country:US
Practice Address - Phone:773-744-3538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.006768103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK12974Medicare PIN
ILK12974Medicare UPIN