Provider Demographics
NPI:1982628905
Name:BERG, JUDY S (LCSW,LMFT)
Entity type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:S
Last Name:BERG
Suffix:
Gender:F
Credentials:LCSW,LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 VILLAS CT
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-3703
Mailing Address - Country:US
Mailing Address - Phone:847-831-5110
Mailing Address - Fax:847-831-5110
Practice Address - Street 1:960 VILLAS CT
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-3703
Practice Address - Country:US
Practice Address - Phone:847-831-5110
Practice Address - Fax:847-831-5110
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL552180Medicare ID - Type UnspecifiedLCSW