Provider Demographics
NPI:1730408725
Name:MERVIS, BONNIE AARON (PHD, LCSW)
Entity type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:AARON
Last Name:MERVIS
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:459 CENTRAL AVE
Mailing Address - Street 2:SUITE #200
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-2622
Mailing Address - Country:US
Mailing Address - Phone:847-432-2113
Mailing Address - Fax:847-433-3135
Practice Address - Street 1:70 HASTINGS AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-5158
Practice Address - Country:US
Practice Address - Phone:847-432-2113
Practice Address - Fax:847-433-3135
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-31
Last Update Date:2010-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490010261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL149001026OtherIL LICENSED CLINICAL SOCIAL WORKER